Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 3060 | TN |
NPI | 1174934855 |
---|---|
Provider Name | Dr. Dustin Parker |
First Address | Newbern, TN 38059-5403 |
Second Address | Memphis, TN 38103-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 06/07/2016 |