Provider Demographics
NPI:1578525382
Name:PARKER, CLEVIS T SR (MD)
Entity Type:Individual
Prefix:
First Name:CLEVIS
Middle Name:T
Last Name:PARKER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1930 VILLAGE CENTER CIR STE 3-400
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6299
Mailing Address - Country:US
Mailing Address - Phone:702-960-4312
Mailing Address - Fax:702-666-8704
Practice Address - Street 1:3340 TOPAZ ST STE 140B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3959
Practice Address - Country:US
Practice Address - Phone:702-960-4312
Practice Address - Fax:702-666-8704
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17763207QH0002X, 207Q00000X
AZ34880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBP6953384OtherDEA
LA4A736DH01Medicare PIN
AZBP6953384OtherDEA