Provider Demographics
NPI:1528023934
Name:PARR, ZACKWRIE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:ZACKWRIE
Middle Name:S
Last Name:PARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 HIGHWAY PP
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3967
Mailing Address - Country:US
Mailing Address - Phone:573-778-0020
Mailing Address - Fax:573-778-1647
Practice Address - Street 1:2002 KANELL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4045
Practice Address - Country:US
Practice Address - Phone:573-785-4959
Practice Address - Fax:573-785-6405
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000617213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO302717715Medicaid
MO188277OtherBLUE CROSS BLUE SHIELD
MO011013495Medicare ID - Type Unspecified
MO188277OtherBLUE CROSS BLUE SHIELD