Provider Demographics
NPI:1932269651
Name:PARKER, ROY FC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:FC
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 580
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0580
Mailing Address - Country:US
Mailing Address - Phone:850-653-8853
Mailing Address - Fax:850-653-1879
Practice Address - Street 1:137 12TH STREET
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2110
Practice Address - Country:US
Practice Address - Phone:850-653-1525
Practice Address - Fax:850-653-1548
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000320-1363AM0700X
FLPA9105839363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010978500Medicaid
NYR11222Medicare UPIN
FL921410106691001Medicare Oscar/Certification