Individual
JEFFREY D PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4315 MEMORIAL DR, BELLEVILLE, IL 62226-5342
(618) 767-7023
Mailing address
4315 MEMORIAL DR, BELLEVILLE, IL 62226-5342
(618) 767-7023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036062597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033308
HEALTH ALLIANCE
—
05
—
036062597
—
IL
01
—
080077375
RAILROAD MEDICARE
—
01
—
10019630
BLUE CROSS
IL
01
—
10019630
BLUE CROSS/BLUE SHIELD
—
01
—
103788
HEALTHLINK
—
05
—
143870
—
IL
Enumeration date
08/24/2006
Last updated
05/09/2023
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