MEDICARE: DR. DARCI RAE PARK DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	881	AZ
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E4589	CA

General Provider Information

NPI Number	:	1760562516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARCI RAE PARK DPM

Provider Business Mailing Address
First Line	:	7620 E MCKELLIPS RD.
Second Line	:	SUITE 4, #225
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257
Country	:	US
Telephone Number	:	888-495-4489
Fax Number	:	602-325-0169

Provider Business Practice Location Address
First Line	:	100 BUSH ST
Second Line	:	SUITE 420
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-3902
Country	:	US
Telephone Number	:	415-956-2884
Fax Number	:	415-956-2662

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/01/2018

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