Healthcare Provider Details

I. General information

NPI: 1598783789
Provider Name (Legal Business Name): PETER J PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W GLENOAKS BLVD
GLENDALE CA
91202-2606
US

IV. Provider business mailing address

PO BOX 5108
GLENDALE CA
91221-2108
US

V. Phone/Fax

Practice location:
  • Phone: 818-546-2626
  • Fax: 818-546-1056
Mailing address:
  • Phone: 310-276-2400
  • Fax: 310-276-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA44924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: