MEDICARE: MR. CHARLES S PARKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD13760	OR
2	207R00000X	Internal Medicine Physician	MD13760	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	930079538	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	059297000	OTHER	BC/BS OF OREGON
2	C93481	OTHER	PROVIDENCE HEALTH PLAN
3	A011	OTHER	CHAMPUS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	C93481	OTHER	GROUP HEALTH
7	XPY195707	OTHER	MEDI-CAL

General Provider Information

NPI Number	:	1710949987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES S PARKER MD

Provider Business Mailing Address
First Line	:	444 NW ELKS DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3745
Country	:	US
Telephone Number	:	541-754-1282
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 NW SAMARITAN DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3737
Country	:	US
Telephone Number	:	541-754-1282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	02/06/2012

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Directions to “ MR. CHARLES S PARKER MD” Practice Location

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