Provider Demographics
NPI:1912957341
Name:PARKER, JAMES LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LARRY
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22670
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2670
Mailing Address - Country:US
Mailing Address - Phone:601-939-0361
Mailing Address - Fax:601-939-5210
Practice Address - Street 1:1020 RIVER OAKS DR
Practice Address - Street 2:SUITE 420
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9500
Practice Address - Country:US
Practice Address - Phone:601-939-0361
Practice Address - Fax:601-939-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS062272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122671Medicaid
MSD73567Medicare UPIN
MS132945679Medicare ID - Type Unspecified