Provider Demographics
NPI:1558502013
Name:R BRUCE PARKER MD PC
Entity Type:Organization
Organization Name:R BRUCE PARKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION HEAD
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-321-2929
Mailing Address - Street 1:3441 24TH AVE NW STE 105
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6716
Mailing Address - Country:US
Mailing Address - Phone:140-532-1292
Mailing Address - Fax:405-366-8701
Practice Address - Street 1:3441 24TH AVE NW STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6716
Practice Address - Country:US
Practice Address - Phone:405-321-2929
Practice Address - Fax:405-366-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100147560AMedicaid
OKD35106Medicare UPIN
OK=========Medicare PIN