Individual
EDWARD Y PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2149 E WARNER RD STE 102, TEMPE, AZ 85284-3495
(480) 610-6100
(480) 464-0189
Mailing address
2149 E WARNER RD, SUITE 101, TEMPE, AZ 85284-3494
(480) 610-6100
(480) 464-0189
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4218
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000483998
BC/BS OF OHIO
OH
05
—
182405
—
AZ
05
—
2675627
—
OH
01
—
4218
ARIZONA STATE LICENSE
AZ
Enumeration date
06/30/2006
Last updated
01/19/2017
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