Provider Demographics
NPI:1770679771
Name:PARRA, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:PARRA
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 1:2800 E COMMERCIAL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4202
Mailing Address - Country:US
Mailing Address - Phone:954-491-0900
Mailing Address - Fax:954-491-1306
Practice Address - Street 1:2800 E COMMERCIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4202
Practice Address - Country:US
Practice Address - Phone:954-491-0900
Practice Address - Fax:954-491-1306
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91240174400000X, 208600000X
FLM912402086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI21220Medicare UPIN
FLU3796ZMedicare ID - Type Unspecified