Healthcare Provider Details

I. General information

NPI: 1962470161
Provider Name (Legal Business Name): ROBERT PARKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W LA VETA AVE STE 108
ORANGE CA
92868
US

IV. Provider business mailing address

845 W LA VETA AVE STE 108
ORANGE CA
92868-3930
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-2600
  • Fax: 714-289-3906
Mailing address:
  • Phone: 714-639-2600
  • Fax: 714-289-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG27430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: