Provider Demographics
NPI:1760454607
Name:PARKINSON, PHILLIP M (CRNA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:PARKINSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 N MACARTHUR BLVD
Mailing Address - Street 2:STE. 220
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2617
Mailing Address - Country:US
Mailing Address - Phone:972-714-0007
Mailing Address - Fax:972-714-0009
Practice Address - Street 1:5605 N MACARTHUR BLVD
Practice Address - Street 2:STE. 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2617
Practice Address - Country:US
Practice Address - Phone:972-714-0007
Practice Address - Fax:972-714-0009
Is Sole Proprietor?:No
Enumeration Date:2006-02-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171481802Medicaid
TX8D2525Medicare PIN
TX171481802Medicaid
TX8J5496Medicare PIN