Provider Demographics
NPI:1699927947
Name:PARK LAKES FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:PARK LAKES FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-996-0068
Mailing Address - Street 1:1305 W. PARKWOOD AVE
Mailing Address - Street 2:SUITE A-107
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-1895
Mailing Address - Country:US
Mailing Address - Phone:281-996-0068
Mailing Address - Fax:281-996-0186
Practice Address - Street 1:1305 W. PARKWOOD AVE
Practice Address - Street 2:SUITE A-107
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-996-0068
Practice Address - Fax:281-996-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty