Provider Demographics
NPI:1801991021
Name:PARKS, ALAN LEE (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
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 1:2108 HUNTER RD
Mailing Address - Street 2:116
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666
Mailing Address - Country:US
Mailing Address - Phone:512-396-4837
Mailing Address - Fax:512-754-0012
Practice Address - Street 1:2108 HUNTER RD
Practice Address - Street 2:116
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5155
Practice Address - Country:US
Practice Address - Phone:512-396-4837
Practice Address - Fax:512-754-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C20221Medicare UPIN
TX0065BAMedicare ID - Type Unspecified