Provider Demographics
NPI:1922070788
Name:PARKER, HOWARD EUGENE (DPM)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:EUGENE
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56830 29 PALMS HWY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2939
Mailing Address - Country:US
Mailing Address - Phone:760-365-1291
Mailing Address - Fax:760-365-1051
Practice Address - Street 1:56830 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2939
Practice Address - Country:US
Practice Address - Phone:760-365-1291
Practice Address - Fax:760-365-1051
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3539213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35391Medicaid
CAU05163Medicare UPIN
CA4860460002Medicare NSC
CA000E35391Medicare PIN
CA000E35391Medicare PIN