Provider Demographics
NPI:1750347720
Name:PARKER, JEFFREY ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 CENTER POINT RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4064
Mailing Address - Country:US
Mailing Address - Phone:319-365-6973
Mailing Address - Fax:319-365-6973
Practice Address - Street 1:3047 CENTER POINT RD NE STE A
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4064
Practice Address - Country:US
Practice Address - Phone:319-365-6973
Practice Address - Fax:319-365-6974
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00733213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433086Medicaid
IAIA02586Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IA0433086Medicaid
IAU81998Medicare UPIN