Provider Demographics
NPI:1720290364
Name:PETER JAHANGIR PARKER, MD, INC.
Entity Type:Organization
Organization Name:PETER JAHANGIR PARKER, MD, INC.
Other - Org Name:PETER J PARKER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:818-546-2626
Mailing Address - Street 1:P.O. BOX 5108
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-2108
Mailing Address - Country:US
Mailing Address - Phone:818-546-2626
Mailing Address - Fax:818-546-1056
Practice Address - Street 1:1106 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2606
Practice Address - Country:US
Practice Address - Phone:818-546-2626
Practice Address - Fax:818-546-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44924207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW872BMedicaid
CAW17807BMedicaid