Provider Demographics
NPI:1275545873
Name:PARENT, JOHN REX (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REX
Last Name:PARENT
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 1:4625 N WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 E WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2713
Practice Address - Country:US
Practice Address - Phone:260-424-5656
Practice Address - Fax:260-424-4511
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1669OtherPHYSICIAN'S HEALTH PLAN
IN000000083765OtherANTHEM
OH0420226Medicaid
IN200014170Medicaid
OH0420226Medicaid
IN1669OtherPHYSICIAN'S HEALTH PLAN
IN055860AMedicare PIN
IN170000182Medicare PIN
IN265070AMedicare PIN
IN000000083765OtherANTHEM