Provider Demographics
NPI:1891801346
Name:PARKINSON, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:PARKINSON
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 1:5314 N 250 W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5691
Mailing Address - Country:US
Mailing Address - Phone:801-225-8484
Mailing Address - Fax:801-225-6170
Practice Address - Street 1:5314 N 250 W
Practice Address - Street 2:SUITE 220
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5691
Practice Address - Country:US
Practice Address - Phone:801-225-8484
Practice Address - Fax:801-225-6170
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT158613-8905207ND0900X
UT158613-1205207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDO7816Medicare UPIN