Provider Demographics
NPI:1568447431
Name:PARKER, SANDRA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KAY
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 FOX HUNT TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3113
Mailing Address - Country:US
Mailing Address - Phone:361-816-5285
Mailing Address - Fax:
Practice Address - Street 1:1101 S MAIN ST
Practice Address - Street 2:ROOM 2419
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4802
Practice Address - Country:US
Practice Address - Phone:817-321-5305
Practice Address - Fax:817-321-5331
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4626207Q00000X
LAL14280R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196335702Medicaid
TX0228173-05OtherMEDICAID GROUP TPI
TX0650970-01OtherMEDICAID GROUP TPI
TX0228173-07OtherMEDICAID GROUP TPI
TX0228082-01OtherMEDICAID GROUP TPI
TX0615978-01OtherMEDICAID GROUP TPI
0831497-03OtherMEDICAID GROUP TPI
TX00J32TOtherMEDICARE GROUP
TX00J33TOtherMEDICARE GROUP
TX0174666-03OtherMEDICAID GROUP TPI
TXPH0004OtherMEDICARE GROUP
TX8L1953Medicare PIN
TX0228082-01OtherMEDICAID GROUP TPI