Provider Demographics
NPI:1568466274
Name:PARKER, CHARLES D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951
Mailing Address - Country:US
Mailing Address - Phone:479-431-2050
Mailing Address - Fax:479-431-2051
Practice Address - Street 1:9755 WEST STATE HWY 22
Practice Address - Street 2:
Practice Address - City:RATCLIFF
Practice Address - State:AR
Practice Address - Zip Code:72951
Practice Address - Country:US
Practice Address - Phone:479-431-2050
Practice Address - Fax:479-431-2051
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9233469001OtherCIGNA
080168244OtherRAILROAD MEDICARE
LA1632244Medicaid
AR111469001Medicaid
AR1970402OtherUNITED HEALTHCARE
AR50188OtherBLUE CROSS/BLUE SHIELD
5334029OtherAETNA
AR17719000000OtherQUALCHOICE
MS03181099Medicaid
OK100072090AMedicaid
OK100072090AMedicaid
AR501887231Medicare PIN
AR50188OtherBLUE CROSS/BLUE SHIELD