Individual
CARSON PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2225 POCATELLO CREEK RD APT A, POCATELLO, ID 83201-2152
(530) 209-6873
Mailing address
2225 POCATELLO CREEK RD APT A, POCATELLO, ID 83201-2152
(530) 209-6873
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
ID
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
ID
Other
Enumeration date
03/27/2018
Last updated
03/27/2018
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