Individual
DR. FREDERICK PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
4011 TALBOT RD S, STE 500, RENTON, WA 98055-5773
(425) 251-5110
(425) 793-7380
Mailing address
PO BOX 59028, RENTON, WA 98058-2028
(425) 251-5110
(425) 793-4707
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A106773
CA
207RG0100X
Gastroenterology Physician
Primary
60653608
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2061516
—
WA
Enumeration date
06/25/2007
Last updated
11/14/2016
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