Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 2016015321 | MO |
NPI | 1023306040 |
---|---|
Provider Name | Dr. Adam Maxwell Parker |
First Address | Saint Louis, MO 63195-2551 |
Second Address | Bridgeton, MO 63044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 26/10/2020 |