Provider Demographics
NPI:1235186651
Name:PARK, PAUL FRANCIS (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:FRANCIS
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:F
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2147 RIVERCHASE OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1836
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-982-0278
Practice Address - Street 1:200 MONTGOMERY HWY
Practice Address - Street 2:STE# 100
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1842
Practice Address - Country:US
Practice Address - Phone:205-421-2114
Practice Address - Fax:205-201-7775
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16962208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000031339Medicaid
AL51046120OtherBLUE CROSS BLUE SHIELD
AL117861OtherMEDICAID/EDS AFC VESTAVIA HILLS
AL102I027856OtherMEDICARE PTAN # ESTABLISH 2009
AL515-97129OtherAL BCBS # AFC VESTAVIA
AL020050785OtherRAILROAD MEDICARE
AL000031339Medicaid
AL000046120Medicare ID - Type Unspecified