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General NPI Number Information
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NPI Number | 1245982800
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Entity Type | Organization
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Legal Business Name | DENTON CARDIOVASCULAR CONSULTING
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 2725 WIND RIVER LN
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City | DENTON
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State | TX
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Zip | 76210-2999
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Country | US
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Telephone | 940-390-2420
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51587
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City | DENTON
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State | TX
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Zip | 76206-1587
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Country | US
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Telephone | 940-367-2953
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Fax |
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Authorized Official
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Title or Position | MBR/MANAGER
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Name | ROBERT CONRAD PARK
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Credential | M.D.
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Telephone | 940-367-2953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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