Provider Demographics
NPI:1598783789
Name:PARKER, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:PARKER
Suffix:
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:PO BOX 5108
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-2108
Mailing Address - Country:US
Mailing Address - Phone:310-276-2400
Mailing Address - Fax:310-276-4634
Practice Address - Street 1:1100 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2606
Practice Address - Country:US
Practice Address - Phone:818-546-2626
Practice Address - Fax:818-546-1056
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44924207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A449240Medicaid
CA00A449240Medicaid
CA00A449240Medicaid