Individual
DR. GEORGE S PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., M.P.
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
MP0983
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314936
MEDICARE PTAN
LA
Enumeration date
06/08/2006
Last updated
01/11/2016
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