Individual
DR. YONG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
506 4TH ST NW, JASPER, FL 32052-6603
(386) 792-7200
(386) 792-2084
Mailing address
506 4TH ST NW, JASPER, FL 32052-6603
(386) 792-7200
(386) 792-2084
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
LL528
FL
207Q00000X
Family Medicine Physician
LL528
FL
208D00000X
General Practice Physician
LL528
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82060
BCBS
FL
01
—
LL528
MEDICAL LICENSE
FL
Enumeration date
11/01/2006
Last updated
01/03/2008
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