Provider Demographics
NPI:1497885339
Name:PARK, CHRISTOPHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 DAUPHIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1725
Mailing Address - Country:US
Mailing Address - Phone:251-340-6600
Mailing Address - Fax:251-479-7164
Practice Address - Street 1:3700 DAUPHIN ST STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1725
Practice Address - Country:US
Practice Address - Phone:251-340-6600
Practice Address - Fax:251-479-7164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-004012086S0105X, 2086S0122X, 2082S0099X, 208200000X
VA01012411622086S0122X, 208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009016Medicaid
AL510I240012OtherRAILROAD MEDICARE PTAN
202030OtherMEDCOST
146F9OtherBCBS
810641OtherPARTNERS
9897073OtherAETNA
AL510I240012OtherMEDICARE PTAN
AL51595045OtherBLUE CROSS BLUE SHIELD
NC5906699Medicaid
SCQ0040LMedicaid
AL51595045OtherBLUE CROSS BLUE SHIELD