Individual
PARK THETFORD CHITTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
509 PARKMAN AVE, SELMA, AL 36701-5734
(334) 874-9064
(334) 874-2633
Mailing address
509 PARKMAN AVE, P.O. BOX 530, SELMA, AL 36701-5734
(334) 874-9064
(334) 874-2633
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5342
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000003686
—
AL
01
—
110191475
RAILROAD MEDICARE
AL
Enumeration date
11/04/2005
Last updated
01/25/2008
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