Individual
RANDAL ALEXANDER PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
100600
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7014643
AETNA
—
01
—
94697
MEDCOST
—
01
—
970025223
RR MEDICARE
—
Enumeration date
11/30/2005
Last updated
11/15/2010
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