Provider Demographics
NPI:1396789806
Name:PARKER, JULES GERARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JULES
Middle Name:GERARD
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2040 SUNSET MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6359
Mailing Address - Country:US
Mailing Address - Phone:757-485-4811
Mailing Address - Fax:757-628-8280
Practice Address - Street 1:930 MAJESTIC AVE 140
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4055
Practice Address - Country:US
Practice Address - Phone:757-628-1597
Practice Address - Fax:757-628-8280
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000907213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA100791OtherMEDICARE PTAN
VA9303693Medicaid
VA9303693Medicaid