Provider Demographics
NPI:1205844420
Name:PARKER, RUSSELL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:BRUCE
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 1:3441 24TH AVE NW STE 105
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6716
Mailing Address - Country:US
Mailing Address - Phone:140-532-1292
Mailing Address - Fax:405-366-8701
Practice Address - Street 1:3441 24TH AVE NW STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6716
Practice Address - Country:US
Practice Address - Phone:405-321-2929
Practice Address - Fax:405-366-8701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15169174400000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100147560AMedicaid
OKD35106Medicare UPIN
OK$$$$$$$$$Medicare PIN