=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891897435
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET M. PARKER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2006
-----------------------------------------------------
Last Update Date | 09/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 59 BANGOR ST STE 3
-----------------------------------------------------
City | HOULTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04730-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-532-7161
-----------------------------------------------------
Fax | 207-532-1090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 BANGOR ST STE 3
-----------------------------------------------------
City | HOULTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04730-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-532-7161
-----------------------------------------------------
Fax | 207-532-1090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 009206
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------