Provider Demographics
NPI:1679501894
Name:PARSONS, DAVID LEROY (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEROY
Last Name:PARSONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 SCOTT'S VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95485-9541
Mailing Address - Country:US
Mailing Address - Phone:707-263-7478
Mailing Address - Fax:
Practice Address - Street 1:8830 SCOTTS VALLEY RD
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485-9541
Practice Address - Country:US
Practice Address - Phone:707-263-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F14829Medicare UPIN