Provider Demographics
NPI:1780690842
Name:PARKER, GERALD L (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:L
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 1:404 GILMORE DR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5414
Mailing Address - Country:US
Mailing Address - Phone:662-256-3564
Mailing Address - Fax:
Practice Address - Street 1:404 GILMORE DR
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-3416
Practice Address - Country:US
Practice Address - Phone:662-256-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4024382Medicaid
MS80004226Medicare ID - Type Unspecified