Healthcare Provider Details

I. General information

NPI: 1568466274
Provider Name (Legal Business Name): CHARLES D PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/07/2023
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 WEST STATE HWY 22
RATCLIFF AR
72951
US

IV. Provider business mailing address

P.O BOX 130
RATCLIFF AR
72951
US

V. Phone/Fax

Practice location:
  • Phone: 479-431-2050
  • Fax: 479-431-2051
Mailing address:
  • Phone: 479-431-2050
  • Fax: 479-431-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-6866
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: