Individual
KENNETH R PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1116 MILLIS AVE, BOONVILLE, IN 47601-2204
(812) 473-0181
(812) 473-5822
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 491-1307
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01037962A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01037962A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042725
BLUE SHIELD
IN
01
—
050052833
RAILROAD MEDICARE
—
05
—
100334280
—
IN
05
—
64872856
—
KY
Enumeration date
05/13/2006
Last updated
10/22/2020
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