Provider Demographics
NPI:1760521132
Name:PARKER, GLENDA FERGUSON (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:FERGUSON
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 1:3615 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4055
Mailing Address - Country:US
Mailing Address - Phone:813-977-0281
Mailing Address - Fax:813-977-0536
Practice Address - Street 1:3615 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4055
Practice Address - Country:US
Practice Address - Phone:813-977-0281
Practice Address - Fax:813-977-0536
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106783207R00000X
MDD0066393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine