Provider Demographics
NPI:1750309811
Name:PARKER, STEVEN WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WALLACE
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 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 705
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-329-0333
Mailing Address - Fax:775-329-6954
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 705
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-329-0333
Practice Address - Fax:775-329-6954
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4095207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016204Medicaid
NV002016204Medicaid