Individual
CHRISTOPHER LANE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
47 S MAIN ST, PONTOTOC, MS 38863-2823
(662) 499-2802
(866) 939-1560
Mailing address
PO BOX 507, PONTOTOC, MS 38863-0507
(662) 499-2802
(866) 939-1560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19482
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06575065
—
MS
Enumeration date
06/12/2007
Last updated
05/05/2026
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