MEDICARE: DR. CHRISTOPHER A PARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0105X	Surgery of the Hand (Surgery) Physician	2007-00401	NC
2	2086S0122X	Plastic and Reconstructive Surgery Physician	2007-00401	NC
3	2086S0122X	Plastic and Reconstructive Surgery Physician	0101241162	VA
4	208200000X	Plastic Surgery Physician	0101241162	VA
5	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	2007-00401	NC
6	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	0101241162	VA
7	208200000X	Plastic Surgery Physician	2007-00401	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	510I240012	OTHER	AL	RAILROAD MEDICARE PTAN
7	510I240012	OTHER	AL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	202030	OTHER		MEDCOST
4	146F9	OTHER		BCBS
5	810641	OTHER		PARTNERS
6	9897073	OTHER		AETNA
8	51595045	OTHER	AL	BLUE CROSS BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497885339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER A PARK M.D.

Provider Business Mailing Address
First Line	:	3700 DAUPHIN ST STE A
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-1725
Country	:	US
Telephone Number	:	251-340-6600
Fax Number	:	251-479-7164

Provider Business Practice Location Address
First Line	:	3700 DAUPHIN ST STE A
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-1725
Country	:	US
Telephone Number	:	251-340-6600
Fax Number	:	251-479-7164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	03/15/2023

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Directions to “ DR. CHRISTOPHER A PARK M.D.” Practice Location

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