Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 41691 | KY |
N | 208600000X | Surgeon | 41691 | KY |
Y | 208200000X | Surgeon | MD206664 | LA |
Y | 208600000X | Surgeon | MD206664 | LA |
NPI | 1003088972 |
---|---|
Provider Name | Dr. Phillip Parker Crace |
First Address | Ferriday, LA 71334 |
Second Address | Ferriday, LA 71334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 22/12/2016 |