Provider Demographics
NPI:1134160724
Name:PARKER, JEFFREY B (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
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 1:934 W HATCHER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-3139
Mailing Address - Country:US
Mailing Address - Phone:602-344-6300
Mailing Address - Fax:602-344-6301
Practice Address - Street 1:934 W HATCHER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-3139
Practice Address - Country:US
Practice Address - Phone:602-344-6300
Practice Address - Fax:602-344-6301
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ259730Medicaid
AZZ134021Medicare PIN
AZ259730Medicaid
AZZ85340Medicare PIN