Provider Demographics
NPI:1700103983
Name:PARKER, TRAVIS ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ALLEN
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 NICOLLS ROAD
Mailing Address - Street 2:LEVEL 2, ROOM 749 DEPT OF PATHOLOGY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7025
Mailing Address - Country:US
Mailing Address - Phone:631-444-2214
Mailing Address - Fax:631-444-3419
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:LEVEL 2, ROOM 749 DEPT. OF PATHOLOGY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7025
Practice Address - Country:US
Practice Address - Phone:631-444-2214
Practice Address - Fax:631-444-3419
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program