Organization
PARK MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM R THOMPSON JR. M.D. (PRESIDENT)
(904) 264-4541
Entity
Organization
Contact information
Practice address
847 PARK AVE, ORANGE PARK, FL 32073-4117
(904) 264-4541
(904) 278-2709
Mailing address
847 PARK AVE, ORANGE PARK, FL 32073-4117
(904) 264-4541
(904) 278-2709
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0012468
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013985035
NPI
—
01
—
1053388306
NPI
—
01
—
1487621736
NPI
—
Enumeration date
06/25/2006
Last updated
06/10/2015
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