Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD-42402 | IA |
NPI | 1063738342 |
---|---|
Provider Name | Charles Allen Parker |
First Address | Dubuque, IA 52002-2201 |
Second Address | Dubuque, IA 52001-7313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 17/07/2015 |