Individual
PAUL PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6325 HUMPHREYS BLVD, MEMPHIS, TN 38120-2300
(901) 522-7700
(901) 522-2600
Mailing address
6325 HUMPHREYS BLVD, MEMPHIS, TN 38120-2300
(901) 522-7700
(901) 522-2600
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
32050
MS
207T00000X
Neurological Surgery Physician
Primary
39675
TN
207T00000X
Neurological Surgery Physician
4301071842
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200001052
—
MS
05
—
4812077
—
MI
05
—
Q076139
—
TN
Enumeration date
09/20/2006
Last updated
08/07/2023
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