Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01080677A | IN |
Y | 207X00000X | Orthopaedic Surgeon | C1-0013058 | DE |
NPI | 1013350016 |
---|---|
Provider Name | Andrew G Park |
First Address | Dover, DE 19901-3530 |
Second Address | Milford, DE 19963-4364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 19/06/2019 |