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NPI Code Detail

MEDICARE: KENNETH R PARKER MD

MEDICARE: KENNETH R 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
1207L00000XAnesthesiology Physician01037962AIN
2207LP2900XPain Medicine (Anesthesiology) Physician01037962AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4050052833OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000042725OTHERINBLUE SHIELD

General Provider Information

NPI Number : 1457302564
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH R PARKER MD
Provider Business Mailing Address
First Line : PO BOX 3276
Second Line :
City : EVANSVILLE
State : IN
Zip : 47731-3276
Country : US
Telephone Number : 812-491-1307
Fax Number : 812-473-5822
Provider Business Practice Location Address
First Line : 1116 MILLIS AVE
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-2204
Country : US
Telephone Number : 812-473-0181
Fax Number : 812-473-5822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 10/22/2020

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Directions to “ KENNETH R PARKER MD” Practice Location

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