Provider Demographics
NPI:1144789405
Name:PARKER, JAMES KEITH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEITH
Last Name:PARKER
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 1:5905 N MAYFAIR ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1127
Mailing Address - Country:US
Mailing Address - Phone:509-456-7414
Mailing Address - Fax:800-247-9519
Practice Address - Street 1:5905 N MAYFAIR ST STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1127
Practice Address - Country:US
Practice Address - Phone:509-456-7414
Practice Address - Fax:800-247-9519
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.61397788207N00000X
MO2020015245207N00000X
MTMED-RES-LIC-77253207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program