Individual
MR. JAMES VANCE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1227 E RUSHOLME ST, DAVENPORT, IA 52803-2498
(563) 421-1000
(563) 421-7889
Mailing address
PO BOX 1245, BETTENDORF, IA 52722-0021
(563) 324-8160
(563) 324-8486
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
28906
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1091116
—
IA
Enumeration date
12/19/2005
Last updated
05/06/2021
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