Most Relevant Information
Provider Data
| NPI Number: | 1003484411 |
| Provider Name: | THAYNE MADSEN PARKER DO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | OT020988 |
Most Important Dates
| Enumeration Date: | 06/12/2021 |
| Last Updated: | 06/12/2021 |
Provider Practice Location
5515 PEACH ST
ERIE
PA
165092603
Practice Location Phone/Fax
| Phone: | 7023385545 |
| Fax: |
Provider Mailing Location
4090 BLACKBERRY LN
ERIE
PA
165061764
Provider Mailing Phone/Fax
| Phone: | 7023385545 |
| Fax: |