Provider Demographics
NPI:1619527371
Name:TIMOTHY, PARKER DON (PA)
Entity Type:Individual
Prefix:MR
First Name:PARKER
Middle Name:DON
Last Name:TIMOTHY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:208 CONCOURSE BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:707-544-3400
Mailing Address - Fax:
Practice Address - Street 1:1194 VINTAGE GREENS DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6864
Practice Address - Country:US
Practice Address - Phone:801-712-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant