Provider Demographics
NPI:1083858260
Name:PARISH, JOHN ALLEN JR (IDMT-P)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLEN
Last Name:PARISH
Suffix:JR
Gender:M
Credentials:IDMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 OSS/ A7M
Mailing Address - Street 2:UNIT 8810 BOX 245 RAF MILDENHALL
Mailing Address - City:BURY ST. EDMUNDS
Mailing Address - State:SUFFOLK
Mailing Address - Zip Code:IP28 8NF
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:352 OSS/ A7M
Practice Address - Street 2:UNIT 8810 BOX 245
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09459-5245
Practice Address - Country:US
Practice Address - Phone:44163-854-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians