Provider Demographics
NPI:1225047590
Name:PARRISH, RICHARD MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARK
Last Name:PARRISH
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 1:2505 SAMARITAN DR
Mailing Address - Street 2:STE 309
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-356-8486
Mailing Address - Fax:408-356-8838
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:STE 309
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-356-8486
Practice Address - Fax:408-356-8838
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G365810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G365810Medicare ID - Type Unspecified
CAA46735Medicare UPIN