Individual
JERRY W. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9222 N NEWPORT HWY, STE 1, SPOKANE, WA 99218-1235
(509) 467-4545
(509) 467-2304
Mailing address
7511 N PANORAMA DR, SPOKANE, WA 99208-8431
(509) 466-3089
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP00001729
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0151371
LABOR AND INDUSTRIES NUMB
WA
01
—
OP00001729
STATE LICENSE NUMBER
WA
Enumeration date
09/20/2006
Last updated
07/08/2007
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