Provider Demographics
NPI:1922432525
Name:PARKER, GARY RICHARD
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:RICHARD
Last Name:PARKER
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 1:5011 NE COUNTY ROAD 1469
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-9289
Mailing Address - Country:US
Mailing Address - Phone:352-475-1566
Mailing Address - Fax:352-475-5984
Practice Address - Street 1:5011 NE COUNTY ROAD 1469
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-9289
Practice Address - Country:US
Practice Address - Phone:352-475-1566
Practice Address - Fax:352-475-5984
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJF5646171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications