Provider Demographics
NPI:1407854441
Name:PARKER, BILL JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:JACK
Last Name:PARKER
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 1:3121 PLATEAU RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-8900
Mailing Address - Country:US
Mailing Address - Phone:704-276-9200
Mailing Address - Fax:704-276-9300
Practice Address - Street 1:3121 PLATEAU RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-8900
Practice Address - Country:US
Practice Address - Phone:704-276-9200
Practice Address - Fax:704-276-9300
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7965234Medicaid
NC562274257OtherTAX ID NUMBER
NC562274257OtherTAX ID NUMBER
NC7965234Medicaid