Individual
DR. INN T PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2323 N ASH ST, NEVADA, MO 64772-1054
(417) 667-7833
Mailing address
RR 6 BOX 85, NEVADA, MO 64772-9773
(417) 667-3010
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
R2A60
MO
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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