Provider Demographics
NPI:1194769703
Name:PARROTT, KENNETH D (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:PARROTT
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 1:124 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEENE
Mailing Address - State:OK
Mailing Address - Zip Code:73763
Mailing Address - Country:US
Mailing Address - Phone:580-822-4404
Mailing Address - Fax:580-822-4403
Practice Address - Street 1:124 N 6TH ST
Practice Address - Street 2:
Practice Address - City:OKEENE
Practice Address - State:OK
Practice Address - Zip Code:73763
Practice Address - Country:US
Practice Address - Phone:580-822-4404
Practice Address - Fax:580-822-4403
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00473633OtherRAILROAD MEDICARE
OK100122630AMedicaid
OK731185962002OtherBCBS
P00473633OtherRAILROAD MEDICARE
OK100122630AMedicaid
OK731185962002OtherBCBS