Provider Demographics
NPI:1235370156
Name:PARKER, EDWARD HENRY
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:HENRY
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HANK
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1575 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-6821
Mailing Address - Country:US
Mailing Address - Phone:707-464-8335
Mailing Address - Fax:707-464-8339
Practice Address - Street 1:4715 VALLEY EAST BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-3584
Practice Address - Country:US
Practice Address - Phone:707-822-3376
Practice Address - Fax:707-822-5053
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant