Individual
ROBERT S PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 60968, CHARLOTTE, NC 28260-0968
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
200300863
NC
207P00000X
Emergency Medicine Physician
Primary
79208
GA
207P00000X
Emergency Medicine Physician
ME142605
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1340U
BCBS PROVIDER NUMBER
NC
05
—
891340U
—
NC
01
—
L2339
FL MEDICARE
FL
05
—
Q0086I
—
SC
Enumeration date
09/06/2006
Last updated
05/05/2020
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