Provider Demographics
NPI:1316207749
Name:RICHARD W. PARKINSON
Entity Type:Organization
Organization Name:RICHARD W. PARKINSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-225-8484
Mailing Address - Street 1:5314 N 250 W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5691
Mailing Address - Country:US
Mailing Address - Phone:801-225-8484
Mailing Address - Fax:801-225-6170
Practice Address - Street 1:5314 N 250 W
Practice Address - Street 2:SUITE 220
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5691
Practice Address - Country:US
Practice Address - Phone:801-225-8484
Practice Address - Fax:801-225-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT158613-1205207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT551849816001Medicaid
UTDO7816Medicare UPIN
UT000057798Medicare PIN