JERRY W. PARK (NPI# 1245337153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245337153 |
| Entity Type | Individual |
| Full Name | JERRY W. PARK |
| Credential | D.O. |
| Practice Address |
9222 N Newport Hwy Ste 1 Spokane WA 99218-1235 |
| Mailing Address |
7511 N Panorama Dr Spokane WA 99208-8431 |
| Practice Telephone | 5094674545 |
| Practice Fax Number | 5094672304 |
| Mailing Telephone | 5094663089 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | OP00001729 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LABOR AND INDUSTRIES NUMB | 0151371 | 01 |
| WA | STATE LICENSE NUMBER | OP00001729 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235254095 | Jerry B Park | Optometrist | 291 North First Street, Jacksonville, AR 72076 | 2007-03-20 |
| 1588707764 | Jerry Park | Chiropractor | 224 S Main St Ste 1, Centerville, UT 84014-2206 | 2007-02-15 |
| 1457381360 | Jerry Edward Park | Counselor | 184 Business Park Drive, Suite 200, Virginia Beach, VA 23462-6533 | 2006-07-04 |
| Street Address |
9222 N NEWPORT HWY STE 1 |
| City | SPOKANE |
| State | WA |
| Zip Code | 99218-1235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407965148 | John Stephen Nall | Family Medicine | 9222 N Newport Hwy, Suite 1, Spokane, WA 99218 | 2006-08-29 |
| 1891244067 | U.S. Healthworks Medical Group of Washington, Ps | Preventive Medicine | 9222 N Newport Hwy, Suite 1, Spokane, WA 99218-1235 | 2016-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891282455 | Timary Mathena | Specialist/Technologist | 11107 North Astor Road, Spokane, WA 99218 | 2018-04-19 |
| 1619423316 | Hi5 Orthodontics | Clinic/Center | 9425 N Nevaa, Suite 100, Spokane, WA 99218 | 2016-09-01 |
| 1245689389 | Heather Beats | Massage Therapist | 101 E. Hastings Rd. Ste G, Spokane, WA 99218 | 2016-06-09 |
| 1770979411 | Sparks Massage LLC-dba Elements Masssage | Massage Therapist | 101 E. Hastings Rd., Spokane, WA 99218 | 2015-04-09 |
| 1902295363 | Annabelle Morgan | Midwife | 11725 N Lincoln Ct, Spokane, WA 99218 | 2015-01-22 |
| 1578967543 | Deana Marie Ray | Massage Therapist | 1231 N Division, Ste 105, Spokane, WA 99218 | 2014-10-20 |
| 1770909889 | Krista Dye | Occupational Therapist | 9827 N Nevada, Spokane, WA 99218 | 2014-03-13 |
| 1265855845 | Breanna Zeis | Massage Therapist | 624 W. Hastings, Suite 16, Spokane, WA 99218 | 2014-02-02 |
| 1730516642 | Christie Nygaard | Massage Therapist | 101 E. Hastings Rd, Spokane, WA 99218 | 2013-10-09 |
| 1629312749 | Michelle Reid | Community Health Worker | 10709 N Madison, Spokane, WA 99218 | 2012-11-15 |
| Find all providers in zip 99218 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750916953 | Bavihealth | Family Medicine | 1314 S. Grand Blvd, Ste 2 #142, Spokane, WA 99202-2131 | 2020-03-08 |
| 1407487648 | Direct Primary Care | Family Medicine | 212 E Central Ave Ste 360, Spokane, WA 99208-4502 | 2020-01-27 |
| 1710234190 | Mayfield Family Medicine Pllc | Family Medicine | 5901 N Lidgerwood St Ste 127, Spokane, WA 99208-1122 | 2012-08-06 |
| 1427329762 | Charles Robert Wolfe | Family Medicine | 16320 E Lincoln Rd, Spokane, WA 99217-9571 | 2012-01-18 |
| 1952687386 | Providence Phsyician Services | Family Medicine | 1919 S. Grand Blvd., Spokane, WA 99203 | 2011-10-31 |
| 1295016145 | Providence Physician Services Co | Family Medicine | 801 W. 5th Ave, Suite 307, Spokane, WA 99204 | 2011-09-06 |
| 1548552326 | Providence Physician Service Co | Family Medicine | 1919 S Grand Ave, Pmg Providence Family Medicine South Grand, Spokane, WA 99204 | 2011-05-11 |
| 1104125418 | David Raymond O'brien | Family Medicine | 1907 W Summit Pkwy Apt 306, Spokane, WA 99201-3133 | 2011-03-25 |
| 1144540915 | Elizabeth A. Turner, Md | Family Medicine | 316 W. Boone, Suite 669, Spokane, WA 99201-2354 | 2010-06-03 |
| 1083949374 | Opportunity Medical | Family Medicine | 16201 E. Indiana Ave, Ste 2300, Spokane, WA 99216-2839 | 2009-10-05 |
| Find all providers in SPOKANE | ||||
Please comment or provide details below to improve the information on JERRY W. PARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.