Provider Demographics
NPI:1740232693
Name:PARKER, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
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:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-361-1020
Mailing Address - Fax:479-361-9118
Practice Address - Street 1:171 N MAESTRI RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-9818
Practice Address - Country:US
Practice Address - Phone:479-361-1020
Practice Address - Fax:479-361-9118
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00424746OtherRR MCR
AR5N513OtherAR BC/BS
AR160764001Medicaid
AR5N513Medicare PIN
AR5N513OtherAR BC/BS
ARI51464Medicare UPIN