Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | K6677 | TX |
NPI | 1336150721 |
---|---|
Provider Name | Robert Warren Parker |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 05/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125297501 | (05) | TX |
125297502 | CSHCN (01) | TX |