Healthcare Provider Details

I. General information

NPI: 1740438183
Provider Name (Legal Business Name): ELIZABETH ARNOLD PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTER ST
MOBILE AL
36604-3301
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1660
  • Fax: 251-415-7468
Mailing address:
  • Phone: 251-415-1660
  • Fax: 251-415-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number117954
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28937
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: