Park, James D
Park, James D is an sole proprietor health care provider with primary practice located at 6501 Eagle Rock Ave Ne Suite A6, Albuquerque NM 87113-2478. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Acupuncturist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Park, James D can be contacted via phone (505) 797-5400.Contact Information
Primary practice address
6501 Eagle Rock Ave Ne Suite A6
Albuquerque NM 87113-2478
Phone: (505) 797-5400
Fax: (505) 797-2905
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Acupuncturist | 171100000X | 866 RX-1 | New Mexico |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 2074 | New Mexico |
Profile Details
| NPI number | 1255396719 |
|---|---|
| LBN Legal business name | Park, James D |
| Credentials | DOM |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 19th, 2006 |
| Last updated | Sep 20th, 2012 - about 12 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 | 1255396719 | NPPES |
| New Mexico | Other | NM 00Q502 | BCBS PT PROVIDER NUMBER |
| New Mexico | Other | NM 00RH82 | BCBS PT PROVIDER NUMBER |
| New Mexico | MEDICAID | 45139024 | BCBS PT PROVIDER NUMBER |
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