Provider Demographics
NPI:1255337226
Name:PARKER, WINFRED (PA)
Entity type:Individual
Prefix:
First Name:WINFRED
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SW 44TH ST
Mailing Address - Street 2:STE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3611
Mailing Address - Country:US
Mailing Address - Phone:405-631-4263
Mailing Address - Fax:405-631-4820
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:STE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3611
Practice Address - Country:US
Practice Address - Phone:405-631-4263
Practice Address - Fax:405-631-4820
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR10945Medicare UPIN