1649417080 NPI number — MR. THEODORE ROBERT PARKER R.PH., MPH

Table of content: MR. THEODORE ROBERT PARKER R.PH., MPH (NPI 1649417080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649417080 NPI number — MR. THEODORE ROBERT PARKER R.PH., MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
THEODORE
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH., MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649417080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 761 BOX 10003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-233-2668
Provider Business Mailing Address Fax Number:
670-233-2670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 AKARI BUILDING GUALO RAI
Provider Second Line Business Practice Location Address:
CHALEN PALE ARNOLD ROAD
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-233-2668
Provider Business Practice Location Address Fax Number:
670-233-2670
Provider Enumeration Date:
01/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0007 , registered in the state of MP ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PH00019323 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)