Healthcare Provider Details

I. General information

NPI: 1194349597
Provider Name (Legal Business Name): DAVID B PARKER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE STE D101
GLENDALE AZ
85308-6040
US

IV. Provider business mailing address

11130 CHRISTUS HILLS MEDICAL PLAZA 3, 3RD FL
SAN ANTONIO TX
78251-3585
US

V. Phone/Fax

Practice location:
  • Phone: 480-245-6211
  • Fax: 480-525-9637
Mailing address:
  • Phone: 210-703-9001
  • Fax: 210-703-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number77442
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77442
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: