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Individual

JADE PARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
301 4TH ST, ALEXANDRIA, LA 71301-8411
(318) 441-1041
Mailing address
301 4TH ST, ALEXANDRIA, LA 71301-8411

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01093877A
IN

Other

Enumeration date
06/09/2021
Last updated
09/12/2024
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