Individual
DR. DOUGLAS S. PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., FACP
Contact information
Practice address
705 W. WADLEY AVE., MIDLAND, TX 79705-5373
(432) 687-4044
(432) 687-0528
Mailing address
705 W WADLEY AVE, MIDLAND, TX 79705-5373
(432) 687-4044
(432) 687-0528
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
752636710
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F15F
MEDICARE ID
TX
05
—
1314593-06
—
TX
Enumeration date
08/10/2005
Last updated
08/19/2013
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