=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992796163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS J PARKS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2005
-----------------------------------------------------
Last Update Date | 07/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14131 MIDWAY RD SUITE 620
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-249-0200
-----------------------------------------------------
Fax | 972-249-0206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14131 MIDWAY RD SUITE 620
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-249-0200
-----------------------------------------------------
Fax | 972-249-0206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 23284
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | P7017
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------