Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A109546 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | A109546 | CA |
NPI | 1114193992 |
---|---|
Provider Name | Mr. Daniel T Parker |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Woodland, CA 95695-5169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 15/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |