Provider Demographics
NPI:1255320768
Name:PARKER, SAMUEL BURTON II (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BURTON
Last Name:PARKER
Suffix:II
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:PO BOX 11339
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1339
Mailing Address - Country:US
Mailing Address - Phone:850-969-7979
Mailing Address - Fax:850-476-9352
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-969-7979
Practice Address - Fax:850-476-9352
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78521207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4139737OtherAETNA
2500250OtherUNITED HEALTHCARE
FL47189OtherBCBS
AL59166822PAROtherBCBS OF ALABAMA
4139737OtherAETNA
FL47189YMedicare ID - Type Unspecified