Healthcare Provider Details

I. General information

NPI: 1235558677
Provider Name (Legal Business Name): JASON RYAN PARKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HOSPITAL DR
ST JOHNSBURY VT
05819-6001
US

IV. Provider business mailing address

323 E CHESTNUT ST
LOUISVILLE KY
40202-1823
US

V. Phone/Fax

Practice location:
  • Phone: 802-473-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number38508
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: