Provider Demographics
NPI:1336110642
Name:PARKER, STEPHEN Q (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:Q
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 1:210 VILLAGE CENTER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6706
Mailing Address - Country:US
Mailing Address - Phone:843-353-3460
Mailing Address - Fax:843-353-3461
Practice Address - Street 1:3545 HIGHWAY 17
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5113
Practice Address - Country:US
Practice Address - Phone:843-294-1941
Practice Address - Fax:843-294-1945
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC192133208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8906174Medicaid
SC192133Medicaid
SC42D2029452OtherCLIA WAIVER
NC8906174Medicaid
SCG520710281Medicare PIN