Healthcare Provider Details

I. General information

NPI: 1528703998
Provider Name (Legal Business Name): PARKER BEATTY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

NMRTC 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 619-881-9011
  • Fax:
Mailing address:
  • Phone: 619-532-7522
  • Fax: 619-532-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0102208059
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: