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General NPI Number Information
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NPI Number | 1659417731
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Entity Type | Individual
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Provider Name | TARA T PARKS DPM
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 2750 BROADWAY ST
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City | BOULDER
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State | CO
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Zip | 80304-3573
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Country | US
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Telephone | 303-440-3036
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Fax | 303-440-3232
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Provider Business Mailing Address
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Address Line | 2750 BROADWAY ST
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City | BOULDER
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State | CO
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Zip | 80304-3573
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Country | US
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Telephone | 303-440-3036
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Fax | 303-440-3232
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-667
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License Number State | CO
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