Provider Demographics
NPI:1710949987
Name:PARKER, CHARLES S (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:S
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 1:444 NW ELKS DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3745
Mailing Address - Country:US
Mailing Address - Phone:541-754-1282
Mailing Address - Fax:
Practice Address - Street 1:3680 NW SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3737
Practice Address - Country:US
Practice Address - Phone:541-754-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13760207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
059297000OtherBC/BS OF OREGON
C93481OtherPROVIDENCE HEALTH PLAN
A011OtherCHAMPUS
OR131235Medicaid
WA8351710Medicaid
C93481OtherGROUP HEALTH
XPY195707OtherMEDI-CAL
930079538OtherRAILROAD MEDICARE
C93481OtherGROUP HEALTH
930079538OtherRAILROAD MEDICARE
C93481OtherPROVIDENCE HEALTH PLAN
ORR139998Medicare PIN