MEDICARE: SANDRA L PARKS MD

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
1	207Q00000X	Family Medicine Physician	20911	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679560700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L PARKS MD

Provider Business Mailing Address
First Line	:	1123 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-4295
Fax Number	:	402-228-3702

Provider Business Practice Location Address
First Line	:	1123 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-4295
Fax Number	:	402-228-3702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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Directions to “ SANDRA L PARKS MD” Practice Location

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