Healthcare Provider Details

I. General information

NPI: 1356817837
Provider Name (Legal Business Name): STEPHANIE M PARKS DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE # 510A
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

500 WALTER ST NE
ALBUQUERQUE NM
87102-2534
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-9922
  • Fax: 505-299-4487
Mailing address:
  • Phone: 505-404-9922
  • Fax: 505-299-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE PARKS
Title or Position: PHYSICIAN
Credential: DPM
Phone: 505-299-4487