Healthcare Provider Details

I. General information

NPI: 1891945457
Provider Name (Legal Business Name): JAMES M. PARKS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR. BLDG 2, STE. 202
AUSTIN TX
78758-5388
US

IV. Provider business mailing address

2200 PARK BEND DR BLDG 2, STE 202
AUSTIN TX
78758-5388
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-0900
  • Fax: 512-836-0902
Mailing address:
  • Phone: 512-836-0900
  • Fax: 512-836-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.A10579
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: