Individual
RANDAL ALEXANDER PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-8018
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-8018
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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