Healthcare Provider Details

I. General information

NPI: 1649258302
Provider Name (Legal Business Name): DAVID PAUL PARKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 S MARYLAND PKWY 315
LAS VEGAS NV
89109-2218
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD #215
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-6868
  • Fax: 702-992-6860
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6998
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number6998
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: