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General NPI Number Information
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NPI Number | 1720218688
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Entity Type | Organization
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Legal Business Name | RALPH PARK, M.D., L.L.C.
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 8901 W 74TH STREET SUITE 124
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204
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Country | US
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Telephone | 913-362-9444
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Fax | 913-362-9399
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Provider Business Mailing Address
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Address Line | 8901 W 74TH STREET SUITE 124
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204
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Country | US
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Telephone | 913-362-9444
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Fax | 913-362-9399
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RALPH H PARK
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Credential | M.D.
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Telephone | 913-653-9812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 04-28712
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License Number State | KS
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