Provider Demographics
NPI:1164477717
Name:PARKER, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:509 E BLUE STARR DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017
Mailing Address - Country:US
Mailing Address - Phone:918-341-7800
Mailing Address - Fax:918-341-7816
Practice Address - Street 1:509 E BLUE STARR DRIVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-341-7800
Practice Address - Fax:918-341-7816
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
731613292001OtherHBSI
OK100108220AMedicaid
2551753OtherAETNA
180042533OtherPALMETTO MEDICARE RAILROA
731613292OtherTAX ID
180042533OtherPALMETTO MEDICARE RAILROA
2551753OtherAETNA
OK100108220AMedicaid