Provider Demographics
NPI:1689650889
Name:PARKER, JEFFREY F (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
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 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-354-0730
Mailing Address - Fax:248-354-0730
Practice Address - Street 1:3200 WALFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4828
Practice Address - Country:US
Practice Address - Phone:707-443-3354
Practice Address - Fax:707-443-3356
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50777207RP1001X
MI4301029520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC1759OtherM'CARE
MI700F314390OtherBLUE SHIELD
MI06340191OtherBCBS INDIVIDUAL
MI1689650889Medicaid
MI700F314390OtherBLUE SHIELD
MIC1759OtherM'CARE