Individual
DR. WILLIAM ISAIAH PARK IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1505 DAPHNE AVE, DAPHNE, AL 36526-4298
(251) 625-2663
(251) 625-3198
Mailing address
1505 DAPHNE AVE, DAPHNE, AL 36526-4298
(251) 625-2663
(251) 625-3198
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
00024958
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0126962
—
MS
01
—
051512928
BCBS
AL
05
—
051552744
—
AL
01
—
200045417
RAILROAD MEDICARE
—
01
—
631187140
TAX ID
—
Enumeration date
05/01/2006
Last updated
08/23/2023
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