Basic Information
| Provider Information | |||||||||
| NPI: | 1598751653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKS | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 TAYLOR STATION RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148633222 | ||||||||
| FaxNumber: | 6148634450 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 TAYLOR STATION RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148633222 | ||||||||
| FaxNumber: | 6148634450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 12/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 35054686P | OH | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 0665856 | 05 | OH | MEDICAID |