Provider Demographics
NPI:1194720854
Name:PARKS, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1123 WILKES BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4774
Mailing Address - Country:US
Mailing Address - Phone:573-815-3573
Mailing Address - Fax:573-445-7285
Practice Address - Street 1:1600 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-3573
Practice Address - Fax:573-445-7285
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8643207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207803719Medicaid
MOA13244Medicare UPIN