Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME62616 | FL |
NPI | 1003053042 |
---|---|
Provider Name | Dianne Mattox Parker |
First Address | Durham, NC 27705-2508 |
Second Address | Fort Lauderdale, FL 33316-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2009 |
Last Update Date | 13/07/2010 |