Provider Demographics
NPI:1447251277
Name:PARKS, ROSS ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:ALLEN
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:160 BOSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32470-4798
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-837-6082
Practice Address - Street 1:2225 NORTH CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2342
Practice Address - Country:US
Practice Address - Phone:407-933-2908
Practice Address - Fax:407-846-1657
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME66619207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376066900Medicaid
FLBP1564827OtherDEA
FL25820XMedicare PIN
FLBP1564827OtherDEA
FL25820WMedicare PIN
FL376066900Medicaid
FL25820YMedicare PIN
FL25820VMedicare PIN