Organization
DOUGLAS S. PARK M.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS S. PARK M.D. (OWNER)
(432) 687-4044
Entity
Organization
Contact information
Practice address
705 W. WADLEY, MIDLAND, TX 79705-5373
(432) 687-4044
(432) 687-0528
Mailing address
705 W. WADLEY, MIDLAND, TX 79705-5373
(432) 687-4044
(432) 687-0528
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
F6298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00395X
MEDICARE PTAN
TX
05
—
131459306
—
TX
Enumeration date
11/03/2008
Last updated
12/08/2011
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