Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 0425136 | KS |
NPI | 1487659959 |
---|---|
Provider Name | Dr. Timothy L Parker |
First Address | Overland Park, KS 66209-2007 |
Second Address | Overland Park, KS 66209-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88346 | (02) |