Provider Demographics
NPI:1891973897
Name:PARMENTER, PAUL ALLEN PAYUMO
Entity Type:Individual
Prefix:
First Name:PAUL ALLEN
Middle Name:PAYUMO
Last Name:PARMENTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18945 FM 2252
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2562
Mailing Address - Country:US
Mailing Address - Phone:210-651-0027
Mailing Address - Fax:
Practice Address - Street 1:18945 FM 2252
Practice Address - Street 2:SUITE 115
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2562
Practice Address - Country:US
Practice Address - Phone:210-651-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF 87711247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist