Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101241162 | VA |
N | 208600000X | Surgeon | 0101241162 | VA |
Y | 208200000X | Surgeon | 2007-00401 | NC |
Y | 208600000X | Surgeon | 2007-00401 | NC |
N | 2086S0105X | Surgery of the Hand | 2007-00401 | NC |
N | 2086S0122X | Plastic and Reconstructive Surgery | 0101241162 | VA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 2007-00401 | NC |
NPI | 1497885339 |
---|---|
Provider Name | Dr. Christopher A Park |
First Address | Mobile, AL 36608-1725 |
Second Address | Mobile, AL 36606-4061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 11/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146F9 | BCBS (01) | |
202030 | MEDCOST (01) | |
3810009016 | (05) | WV |
510I240012 | MEDICARE PTAN (01) | AL |
510I240012 | RAILROAD MEDICARE PTAN (01) | AL |
51595045 | BLUE CROSS BLUE SHIELD (01) | AL |
5906699 | (05) | NC |
810641 | PARTNERS (01) | |
9897073 | AETNA (01) | |
Q0040L | (05) | SC |