Provider Demographics
NPI:1386478014
Name:PARKES, STEPHEN JAMES
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:PARKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:PARKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JD, PSS
Mailing Address - Street 1:12272 106TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-9519
Mailing Address - Country:US
Mailing Address - Phone:701-521-5122
Mailing Address - Fax:
Practice Address - Street 1:12272 106TH ST NE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-9519
Practice Address - Country:US
Practice Address - Phone:701-521-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND356175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist