Provider Demographics
NPI:1538252895
Name:PARKER, ROBERT BRANNON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRANNON
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 1:1100 TED A CROZIER SR BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8912
Mailing Address - Country:US
Mailing Address - Phone:931-649-1699
Mailing Address - Fax:931-552-0906
Practice Address - Street 1:1100 TED A CROZIER SR BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8912
Practice Address - Country:US
Practice Address - Phone:931-648-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110182883OtherRAILROAD MEDICARE
TN3822381Medicaid
TN3110193OtherBLUE CROSS
TN3822381Medicare PIN
TND69481Medicare UPIN