Provider Demographics
NPI:1912051921
Name:PARKER, JEREMIAH JASON (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:JASON
Last Name:PARKER
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 HALCYON SUMMIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117
Mailing Address - Country:US
Mailing Address - Phone:334-277-3492
Mailing Address - Fax:334-277-9432
Practice Address - Street 1:7200 HALCYON SUMMIT DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-277-3492
Practice Address - Fax:334-277-9432
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009998947Medicaid
AL009942913Medicaid
AL51549243OtherBCBS OF ALABAMA
AL51005746OtherBCBS ALABAMA
AL009998948Medicaid
AL51549243OtherBCBS OF ALABAMA
1433222OtherUNITED CONCORDIA
AL009998948Medicaid
AL51549243OtherBCBS OF ALABAMA
AL51047385OtherBCBS OF ALABAMA