Provider Demographics
NPI:1710272265
Name:PARKER, JONATHAN D (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:PARKER
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 1:2410 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-3283
Mailing Address - Country:US
Mailing Address - Phone:256-386-0808
Mailing Address - Fax:256-381-8501
Practice Address - Street 1:2410 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3283
Practice Address - Country:US
Practice Address - Phone:256-386-0808
Practice Address - Fax:563-898-9042
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL160304Medicaid
AL10208I3134Medicare PIN