Healthcare Provider Details

I. General information

NPI: 1700854544
Provider Name (Legal Business Name): MALCOLM BRUCE PARKER III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MALCOLM BRUCE PARKER M.D.

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GARCES HWY
DELANO CA
93215-3690
US

IV. Provider business mailing address

PO BOX 661972
ARCADIA CA
91066-1972
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-4800
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number48507
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC38119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: