Individual
JACK PARKS ARTHUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4227
SC
363A00000X
Physician Assistant
—
SC
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4927PA
—
SC
01
—
SCL8957628
MEDICARE PIN
SC
Enumeration date
11/03/2021
Last updated
04/04/2024
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