Provider Demographics
NPI:1497781637
Name:PARKER, JOHN F JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:PARKER
Suffix:JR
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 1:101 LAGUNA RD STE A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3635
Mailing Address - Country:US
Mailing Address - Phone:714-879-0050
Mailing Address - Fax:714-879-0249
Practice Address - Street 1:101 LAGUNA RD
Practice Address - Street 2:SUITE A
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3613
Practice Address - Country:US
Practice Address - Phone:714-879-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A33942Medicare UPIN