Healthcare Provider Details

I. General information

NPI: 1467430959
Provider Name (Legal Business Name): HARRY H PARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N 16TH ST STE 200
SPRINGFIELD OR
97477-4175
US

IV. Provider business mailing address

960 N 16TH ST STE 200
SPRINGFIELD OR
97477-4175
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3330
  • Fax: 541-242-4364
Mailing address:
  • Phone: 541-228-3330
  • Fax: 541-242-4364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD24583
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: