Provider Demographics
NPI:1457301731
Name:PARKER, JOSE JAMES (PA C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JAMES
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8475
Mailing Address - Country:US
Mailing Address - Phone:541-779-1672
Mailing Address - Fax:541-779-0986
Practice Address - Street 1:2900 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8475
Practice Address - Country:US
Practice Address - Phone:541-779-1672
Practice Address - Fax:541-779-0986
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00759363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical