Provider Demographics
NPI:1659348647
Name:PARKER, PAUL CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CRAIG
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 1:121 LAKEVIEW CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7513
Mailing Address - Country:US
Mailing Address - Phone:985-893-1070
Mailing Address - Fax:985-893-1083
Practice Address - Street 1:121 LAKEVIEW CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7513
Practice Address - Country:US
Practice Address - Phone:985-893-1070
Practice Address - Fax:985-893-1083
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339555Medicaid
LA4M878OtherMEDICARE
LA1339555Medicaid
LAL0939Medicare PIN