Provider Demographics
NPI:1659640183
Name:PARRA, JOSE DUARTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DUARTE
Last Name:PARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2415 W VINE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3731
Mailing Address - Country:US
Mailing Address - Phone:209-333-3121
Mailing Address - Fax:209-339-1033
Practice Address - Street 1:2415 W VINE ST STE 105
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3731
Practice Address - Country:US
Practice Address - Phone:209-333-3121
Practice Address - Fax:209-339-1033
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA121908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine