Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | E-10247 | AR |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | EL07728 | NH |
N | 207Q00000X | Family Doctor | E-10247 | AR |
Y | 207Q00000X | Family Doctor | EL07728 | NH |
NPI | 1124387139 |
---|---|
Provider Name | Dr. Ian Chase Parker |
First Address | Gorham, NH 03581-1502 |
Second Address | Gorham, NH 03581-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2012 |
Last Update Date | 20/10/2021 |