Individual
DR. JAMES D PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DOM
Contact information
Practice address
6501 EAGLE ROCK AVE NE, SUITE A6, ALBUQUERQUE, NM 87113-2478
(505) 797-5400
(505) 797-2905
Mailing address
7343 WILD OLIVE AVE NE, ALBUQUERQUE, NM 87113-2079
(505) 514-2900
(505) 884-5159
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
866 RX-1
NM
225100000X
Physical Therapist
Primary
2074
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45139024
—
NM
01
—
NM 00Q502
BCBS PT PROVIDER NUMBER
NM
01
—
NM 00RH82
BCBS DOM PROVIDER NUMBER
NM
Enumeration date
04/19/2006
Last updated
09/20/2012
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