Provider Demographics
NPI:1467480202
Name:PARKER, CLAUDE JACKSON III (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:JACKSON
Last Name:PARKER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C. JACK
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5127 S ORANGE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3000
Mailing Address - Country:US
Mailing Address - Phone:407-841-1491
Mailing Address - Fax:407-841-1493
Practice Address - Street 1:5127 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3000
Practice Address - Country:US
Practice Address - Phone:407-841-1491
Practice Address - Fax:407-841-1493
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50072207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180027261OtherRR MEDICARE
FL049443300Medicaid
FL180027261OtherRR MEDICARE
FLD84898Medicare UPIN