Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003083726 |
---|---|
Provider Name | Ron Alfred Parker |
First Address | Farmington, MO 63640-1955 |
Second Address | Farmington, MO 63640-1955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 12/05/2008 |