Parks, Willie Joe
Parks, Willie Joe is an individual health care provider with primary practice located at 815 S Fleishel Ave , Tyler TX 75701-2017. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Parks, Willie Joe can be contacted via phone (903) 526-7977.Contact Information
Primary practice address
815 S Fleishel Ave
Tyler TX 75701-2017
Phone: (903) 526-7977
Fax: (903) 526-7989
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 17107 | Texas |
Profile Details
| NPI number | 1306918172 |
|---|---|
| LBN Legal business name | Parks, Willie Joe |
| Credentials | D.D.S., M.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 15th, 2006 |
| Last updated | Mar 25th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306918172 | NPPES |
| Texas | MEDICAID | 1113110-02 | |
| Texas | MEDICAID | 1113110-03 | |
| Texas | MEDICAID | 0808586-01 |
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