Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 31562 | AL |
NPI | 1194043521 |
---|---|
Provider Name | Christopher Trey Parks |
First Address | Huntsville, AL 35801-4306 |
Second Address | Huntsville, AL 35801-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2010 |
Last Update Date | 01/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194043521 | TRICARE (01) | |
188192 | (05) | AL |
511-80390 | BCBS (01) | AL |