Individual
MR. DOUGLAS STEPHEN PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 EAST 17TH STREET, CHEYENNE, WY 82001-4797
(307) 632-2434
(307) 634-9295
Mailing address
820 EAST 17TH STREET, CHEYENNE, WY 82001-4797
(307) 777-7911
(307) 638-3616
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5327A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080104221
RR MEDICARE
WY
05
—
100074800
—
WY
01
—
306424
BCBS
WY
Enumeration date
10/17/2006
Last updated
07/08/2007
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