Provider Demographics
NPI:1689866535
Name:PARKER, DAINA WYATT (MD)
Entity Type:Individual
Prefix:
First Name:DAINA
Middle Name:WYATT
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-2408
Mailing Address - Country:US
Mailing Address - Phone:225-358-3940
Mailing Address - Fax:225-358-3939
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2408
Practice Address - Country:US
Practice Address - Phone:225-358-3940
Practice Address - Fax:225-358-3939
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202167207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00875992OtherRRMCARE THRU PEPA
TX286634501Medicaid
TX1689866535OtherTRICARE SOUTH
TX286634502Medicaid
TX8CY557OtherBCBS
LA1006491Medicaid
LA1006491Medicaid
TX8CY557OtherBCBS
TX286634502Medicaid
LA4P257CQ60Medicare PIN