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Individual
JENNIFER PARK
Active
Individual
JENNIFER PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52982
AZ
207Q00000X
Family Medicine Physician
R74065
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R74065
TRAINING PERMIT
AZ
Enumeration date
06/24/2013
Last updated
07/16/2019
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