Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 35053127 | OH |
NPI | 1023033479 |
---|---|
Provider Name | Dr. Michael P. Parker |
First Address | Columbus, OH 43235-4417 |
Second Address | Bryan, OH 43506-1690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 29/01/2009 |