Provider Demographics
NPI:1649315219
Name:PARKS, DAVID ALAN (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3204
Mailing Address - Country:US
Mailing Address - Phone:314-652-0100
Mailing Address - Fax:314-531-1768
Practice Address - Street 1:3960 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3204
Practice Address - Country:US
Practice Address - Phone:314-652-0100
Practice Address - Fax:314-652-0125
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208695320Medicaid
1013532Medicare ID - Type Unspecified
MO208695320Medicaid