Provider Demographics
NPI:1700854544
Name:PARKER, MALCOLM BRUCE III
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:BRUCE
Last Name:PARKER
Suffix:III
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MALCOLM
Other - Middle Name:BRUCE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 661972
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1972
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1401 GARCES HWY
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3690
Practice Address - Country:US
Practice Address - Phone:661-725-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38119207PE0004X
MN48507207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C381190Medicaid
CAA36848Medicare UPIN
CA00C381190Medicaid