Provider Demographics
NPI:1801835343
Name:PARKER, DONALD RICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICKY
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 CLIFF GOOKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6749
Mailing Address - Country:US
Mailing Address - Phone:662-840-2131
Mailing Address - Fax:662-840-2522
Practice Address - Street 1:1265 CLIFF GOOKIN BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6749
Practice Address - Country:US
Practice Address - Phone:662-840-2131
Practice Address - Fax:662-840-2522
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115001Medicaid
MS00115001Medicaid
MSF46522Medicare UPIN