Provider Demographics
NPI:1356369813
Name:PARKS, BECKY JO (MD)
Entity type:Individual
Prefix:DR
First Name:BECKY
Middle Name:JO
Last Name:PARKS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3293
Mailing Address - Fax:314-747-1345
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 6C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3293
Practice Address - Fax:314-747-1345
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-11-14
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Provider Licenses
StateLicense IDTaxonomies
MO1031552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206653719Medicaid
IL$$$$$$$$$Medicaid
MO149010101Medicare PIN
MO130025467Medicare PIN