Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 07000395A | IN |
NPI | 1013902089 |
---|---|
Provider Name | Matthew A Parmenter |
First Address | Bloomington, IN 47403-4221 |
Second Address | Bloomington, IN 47403-4221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T34662 | (02) |