Individual
DANIEL ILWOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504
(210) 916-4808
(210) 916-3366
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-4808
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31126
NE
208D00000X
General Practice Physician
Primary
31126
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/22/2017
Last updated
04/10/2026
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