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General NPI Number Information
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NPI Number | 1609161330
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Entity Type | Individual
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Provider Name | MARY PARK MD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 939 CAROLINE ST # 3E
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City | PORT ANGELES
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State | WA
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Zip | 98362-3909
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Country | US
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Telephone | 360-565-0599
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Fax | 360-452-7303
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | PORT ANGELES
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State | WA
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Zip | 98362-0146
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Country | US
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Telephone |
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Fax |
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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 | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 280368
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD61579915
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License Number State | WA
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