Provider Demographics
NPI:1407808421
Name:PARKER OB/GYN
Entity Type:Organization
Organization Name:PARKER OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-841-5353
Mailing Address - Street 1:16830 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5776
Mailing Address - Country:US
Mailing Address - Phone:303-841-5353
Mailing Address - Fax:303-758-0779
Practice Address - Street 1:16830 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5776
Practice Address - Country:US
Practice Address - Phone:303-841-5353
Practice Address - Fax:303-758-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD24132Medicare UPIN