Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | FP6094560 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2016-00970 | NC |
NPI | 1114211794 |
---|---|
Provider Name | Dr. Benjamin Raymond Parker |
First Address | Boone, NC 28607-5000 |
Second Address | Boone, NC 28607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 28/08/2018 |