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Individual

MR. CHARLES S PARKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3680 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 754-1282
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1282

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD13760
OR
207R00000X
Internal Medicine Physician
MD13760
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
059297000
BC/BS OF OREGON
05
131235
OR
05
8351710
WA
01
930079538
RAILROAD MEDICARE
01
A011
CHAMPUS
01
C93481
PROVIDENCE HEALTH PLAN
01
XPY195707
MEDI-CAL
Enumeration date
04/04/2006
Last updated
02/06/2012
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