Provider Demographics
NPI:1740234616
Name:PARKER, PAMELA D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:D
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 1:825 N GRAND AVE STE 0
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2292
Mailing Address - Country:US
Mailing Address - Phone:520-761-2128
Mailing Address - Fax:520-281-1112
Practice Address - Street 1:1209 W TARGET RANGE RD STE 100
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2465
Practice Address - Country:US
Practice Address - Phone:520-287-4747
Practice Address - Fax:520-281-4487
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2138207V00000X
AZ32169207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3995805-01Medicaid
TXH08LH44101OtherBCBS-TX
AZ32169OtherARIZONA MEDICAL BOARD LICENSE