Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2001014711 | MO |
Y | 207R00000X | Internist | 2001014711 | MO |
Y | 111NI0900X | Internist | 2001014711 | MO |
NPI | 1013003664 |
---|---|
Provider Name | Jaya Parker |
First Address | Hermann, MO 65041-0019 |
Second Address | Hermann, MO 65041-1571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205431000 | (05) | MO |
G63307 | (02) |