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General NPI Number Information
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NPI Number | 1386645521
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Entity Type | Individual
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Provider Name | DOUGLAS S. PARK M.D., FACP
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 705 W. WADLEY AVE.
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City | MIDLAND
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State | TX
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Zip | 79705-5373
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Country | US
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Telephone | 432-687-4044
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Fax | 432-687-0528
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Provider Business Mailing Address
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Address Line | 705 W WADLEY AVE
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City | MIDLAND
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State | TX
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Zip | 79705-5373
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Country | US
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Telephone | 432-687-4044
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Fax | 432-687-0528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 752636710
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License Number State | TX
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