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NPI Code Detail

MEDICARE: JEFFREY D PARKS M.D.

MEDICARE: JEFFREY D PARKS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036062597IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080077375OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110019630OTHERILBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5033308OTHERHEALTH ALLIANCE
610019630OTHERBLUE CROSS/BLUE SHIELD
7103788OTHERHEALTHLINK

General Provider Information

NPI Number : 1215044367
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY D PARKS M.D.
Provider Business Mailing Address
First Line : 4315 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5342
Country : US
Telephone Number : 618-767-7023
Fax Number :
Provider Business Practice Location Address
First Line : 4315 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5342
Country : US
Telephone Number : 618-767-7023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 05/09/2023

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