Provider Demographics
NPI:1770692709
Name:PARKER, BILL J (PA/C)
Entity type:Individual
Prefix:MR
First Name:BILL
Middle Name:J
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA/C
Other - Prefix:MR
Other - First Name:BIL
Other - Middle Name:J
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA/C
Mailing Address - Street 1:77 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2148
Mailing Address - Country:US
Mailing Address - Phone:303-819-2025
Mailing Address - Fax:720-494-0995
Practice Address - Street 1:77 BAYLOR DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-2148
Practice Address - Country:US
Practice Address - Phone:303-819-2025
Practice Address - Fax:720-494-0995
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO519363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801456Medicare ID - Type UnspecifiedPA/C
COC801456Medicare PIN
COP25949Medicare UPIN