Basic Information
| Provider Information | |||||||||
| NPI: | 1568466274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O BOX 130 | ||||||||
| Address2: | |||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794312050 | ||||||||
| FaxNumber: | 4794312051 | ||||||||
| Practice Location | |||||||||
| Address1: | 9755 WEST STATE HWY 22 | ||||||||
| Address2: | |||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794312050 | ||||||||
| FaxNumber: | 4794312051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C-6866 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9233469001 | 01 | CIGNA | OTHER | AP3160013 | 01 | AR | DEA NUMBER | OTHER | 080168244 | 01 | RAILROAD MEDICARE | OTHER | 1632244 | 05 | LA | MEDICAID | 111469001 | 05 | AR | MEDICAID | 1970402 | 01 | AR | UNITED HEALTHCARE | OTHER | 50188 | 01 | AR | BLUE CROSS/BLUE SHIELD | OTHER | 5334029 | 01 | AETNA | OTHER | 17719000000 | 01 | AR | QUALCHOICE | OTHER | 03181099 | 05 | MS | MEDICAID | 100072090A | 05 | OK | MEDICAID |