Provider Demographics
NPI:1295734507
Name:PARKS, RICHARD L (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:PARKS MD A PROF CORP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12486 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1005
Mailing Address - Country:US
Mailing Address - Phone:562-693-0756
Mailing Address - Fax:562-693-2371
Practice Address - Street 1:12486 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:562-693-0756
Practice Address - Fax:562-693-2371
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-10-07
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
CAG47152207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G47152Medicaid
CAA50610Medicare UPIN
CAG47152Medicare ID - Type Unspecified