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NPI Code Detail

MEDICARE: ALICE PARK MD

MEDICARE: ALICE PARK 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
12084P0800XPsychiatry PhysicianL8157TX

General Provider Information

NPI Number : 1891795076
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICE PARK MD
Provider Business Mailing Address
First Line : 3749 WHISPERING CREEK CIR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-2329
Country : US
Telephone Number : 209-952-5156
Fax Number :
Provider Business Practice Location Address
First Line : 1305 TOMMYDON ST
Second Line :
City : STOCKTON
State : CA
Zip : 95210-3364
Country : US
Telephone Number : 209-476-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 12/27/2021

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Directions to “ ALICE PARK MD” Practice Location

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