Provider Demographics
NPI:1437160173
Name:PARKER, JEFFREY CARL (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CARL
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 1:4100 LAKE OTIS PKWY, SUITE 308
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-563-2663
Mailing Address - Fax:907-333-2948
Practice Address - Street 1:4100 LAKE OTIS PKWY, SUITE 308
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-563-2663
Practice Address - Fax:907-333-2948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4625207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD4625Medicaid
AKD25527Medicare UPIN
AK8EZ65FMedicare ID - Type Unspecified