Healthcare Provider Details

I. General information

NPI: 1336134352
Provider Name (Legal Business Name): JOEL E PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N 24TH PKWY 203
PHOENIX AZ
85016-2024
US

IV. Provider business mailing address

6245 N 24TH PKWY 203
PHOENIX AZ
85016-2024
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-0035
  • Fax:
Mailing address:
  • Phone: 602-843-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21061
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: