Provider Demographics
NPI:1790892982
Name:PARKER, DONNA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
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 1:10708 TOWNE PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4853
Mailing Address - Country:US
Mailing Address - Phone:505-296-0910
Mailing Address - Fax:
Practice Address - Street 1:10708 TOWNE PARK DRIVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:59022-4853
Practice Address - Country:US
Practice Address - Phone:406-638-3500
Practice Address - Fax:406-638-3569
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9835207Q00000X
NMMD2012-0719207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38768Medicare UPIN