Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS0000003337 | TN |
NPI | 1457428708 |
---|---|
Provider Name | Dr. Charles Orville Parker III |
First Address | Johnson City, TN 37601-2947 |
Second Address | Johnson City, TN 37601-2062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 16/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1532259 | (05) | TN |