Provider Demographics
NPI:1942299565
Name:PARKER, JEFFERY E (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:E
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 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-6942
Mailing Address - Fax:740-356-7851
Practice Address - Street 1:1711 27TH ST STE 402
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-3562
Practice Address - Fax:740-355-6938
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44265208600000X
WV22573208600000X
PAMD072108208600000X
OH35094012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2780861Medicaid
WV3810009490Medicaid
KY7100039460Medicaid
P00407338OtherMEDICARE RAILROAD
P00407338OtherMEDICARE RAILROAD