Healthcare Provider Details

I. General information

NPI: 1700990074
Provider Name (Legal Business Name): ROY B PARKE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 E FRONT ST
BUCHANAN MI
49107-1407
US

IV. Provider business mailing address

PO BOX 437
BUCHANAN MI
49107-0437
US

V. Phone/Fax

Practice location:
  • Phone: 269-695-0262
  • Fax:
Mailing address:
  • Phone: 269-695-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101010822
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: