Provider Demographics
NPI:1255361606
Name:PARKER MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:PARKER MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:480-924-9797
Mailing Address - Street 1:6820 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3705
Mailing Address - Country:US
Mailing Address - Phone:480-924-9797
Mailing Address - Fax:480-924-8508
Practice Address - Street 1:6820 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3705
Practice Address - Country:US
Practice Address - Phone:480-924-9797
Practice Address - Fax:480-924-8508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ109410Medicare PIN