Provider Demographics
NPI:1346655339
Name:PARMER, BRADEN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:DOUGLAS
Last Name:PARMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:750 BROADWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1411
Mailing Address - Country:US
Mailing Address - Phone:260-423-2682
Mailing Address - Fax:260-422-4326
Practice Address - Street 1:750 BROADWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1411
Practice Address - Country:US
Practice Address - Phone:260-423-2675
Practice Address - Fax:260-399-4243
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK32999207Q00000X
IN11017886A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine