Healthcare Provider Details

I. General information

NPI: 1184696460
Provider Name (Legal Business Name): ROBERT THOMAS PARRISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 N STATE RT 91 STE 300
PEORIA IL
61615
US

IV. Provider business mailing address

8600 N STATE RT 91 STE 300
PEORIA IL
61615
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-6616
  • Fax: 309-691-2943
Mailing address:
  • Phone: 309-691-6616
  • Fax: 309-691-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: