Provider Demographics
NPI:1003893827
Name:PARKER, JOHN R (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0214
Mailing Address - Country:US
Mailing Address - Phone:502-852-1648
Mailing Address - Fax:502-852-2046
Practice Address - Street 1:530 S. JACKSON ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-6395
Practice Address - Fax:502-852-1761
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38910207ZF0201X, 207ZN0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76517Medicare UPIN
KY0285233Medicare ID - Type Unspecified