Provider Demographics
NPI:1891705059
Name:PARKER, JOHN MATT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATT
Last Name:PARKER
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 1:3713 W 15TH ST
Mailing Address - Street 2:STE 402
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-596-5900
Mailing Address - Fax:972-596-1208
Practice Address - Street 1:3713 W 15TH ST
Practice Address - Street 2:STE 402
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-596-5900
Practice Address - Fax:972-596-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7233207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115611901Medicaid
TX568522ZZN2OtherMEDICARE
C20216Medicare UPIN
TX115611901Medicaid