Park, Christopher Lane
Park, Christopher Lane is an individual health care provider with primary practice located at 11 E Jefferson St , Pontotoc MS 38863-2807. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Park, Christopher Lane can be contacted via phone (662) 499-2802.Contact Information
Primary practice address
11 E Jefferson St
Pontotoc MS 38863-2807
Phone: (662) 499-2802
Fax: (866) 939-1560
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 19482 | Mississippi |
Profile Details
| NPI number | 1710181078 |
|---|---|
| LBN Legal business name | Park, Christopher Lane |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2007 |
| Last updated | Mar 4th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710181078 | NPPES |
| Mississippi | MEDICAID | 06575065 |
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