Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD35052 | MO |
N | 111NI0900X | Internist | MD35052 | MO |
N | 207RG0300X | Geriatric Medicine | MD35052 | MO |
NPI | 1063462117 |
---|---|
Provider Name | Gary Joe Parker |
First Address | Columbia, MO 65201-5275 |
Second Address | Columbia, MO 65201-5275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |