Individual
DR. JOON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3502 9TH ST, SUITE 290, LUBBOCK, TX 79415-3300
(806) 743-1540
(806) 743-3908
Mailing address
PO BOX 5865, LUBBOCK, TX 79408-5865
(806) 743-2898
(806) 743-2787
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
E9904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44268
PRESBYTERIAN COMMERCIAL
NM
05
—
44268
—
NM
01
—
80896Z
HMO BLUE
TX
01
—
85E551
BC/BS
TX
01
—
A078
TRIWEST
NM
05
—
V3884
—
NM
Enumeration date
11/09/2005
Last updated
07/13/2007
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