Provider Demographics
NPI:1124207410
Name:ROBERT E PARKER DPM
Entity Type:Organization
Organization Name:ROBERT E PARKER DPM
Other - Org Name:CIRCLE CITY PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-352-9228
Mailing Address - Street 1:3838 SHERMAN DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-352-9228
Mailing Address - Fax:951-352-9357
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-352-9228
Practice Address - Fax:951-352-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1386213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75892ZMedicare PIN