Healthcare Provider Details

I. General information

NPI: 1497781637
Provider Name (Legal Business Name): JOHN F. PARKER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAGUNA RD SUITE A
FULLERTON CA
92835-3613
US

IV. Provider business mailing address

101 LAGUNA RD STE A
FULLERTON CA
92835-3635
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-0050
  • Fax:
Mailing address:
  • Phone: 714-879-0050
  • Fax: 714-879-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC29494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: