Individual
JASON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 W STONE DR, STE 4B, KINGSPORT, TN 37660-3256
(423) 578-1570
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2091
(423) 857-2012
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
42228
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000606
—
TN
Enumeration date
06/06/2007
Last updated
09/23/2009
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