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General NPI Number Information
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NPI Number | 1477544658
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Entity Type | Individual
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Provider Name | JON CHARLES PARKS MD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 3715 N OLIVER ST
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City | WICHITA
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State | KS
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Zip | 67220-3404
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Country | US
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Telephone | 316-942-4519
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Fax | 316-942-4655
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Provider Business Mailing Address
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Address Line | 3715 N OLIVER ST
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City | WICHITA
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State | KS
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Zip | 67220-3404
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Country | US
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Telephone | 316-942-4519
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Fax | 316-942-4655
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 0423274
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License Number State | KS
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