Individual
DAVID PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4800 MAINE ST, QUINCY, IL 62305-5875
(217) 214-0444
Mailing address
612 N 11TH ST, QUINCY, IL 62301-2662
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036.160411
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2019
Last updated
07/04/2024
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