Provider Demographics
NPI:1386444990
Name:PARKER, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 W ALEX LOOP
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-2445
Mailing Address - Country:US
Mailing Address - Phone:279-333-9449
Mailing Address - Fax:
Practice Address - Street 1:5757 W THUNDERBIRD RD STE E151
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4685
Practice Address - Country:US
Practice Address - Phone:602-865-4570
Practice Address - Fax:602-865-4575
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant