Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Frederick Kim Park, MD

Individual provider Plastic Surgery Physician · NPI 1407964547

Frederick Kim Park, MD is a Plastic and Reconstructive Surgery in Rocky Mount, North Carolina. Graduated from University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb) in 1983, 43 years ago. Practices with James River Dermatology PLLC, a 9-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
43
Trained at
University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb)
Licensed in
NC
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

4008 Capital Dr
Rocky Mount, NC 27804
Phone: (252) 937-5003
Fax: (252) 937-3020
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X · Licence 36793 (NC)

Record details

NPI number1407964547
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 28, 2006
Last updated in NPPESAugust 11, 2025
Certification dateAugust 11, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPLASTIC AND RECONSTRUCTIVE SURGERY
Medical schoolUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated 1983 (43 years in practice)
Group practice James River Dermatology Pllc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare