Healthcare Provider Details

I. General information

NPI: 1497885339
Provider Name (Legal Business Name): CHRISTOPHER A PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 DAUPHIN ST STE A
MOBILE AL
36608-1725
US

IV. Provider business mailing address

3700 DAUPHIN ST STE A
MOBILE AL
36608-1725
US

V. Phone/Fax

Practice location:
  • Phone: 251-340-6600
  • Fax: 251-479-7164
Mailing address:
  • Phone: 251-340-6600
  • Fax: 251-479-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number2007-00401
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2007-00401
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101241162
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101241162
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number2007-00401
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number0101241162
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2007-00401
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: