Healthcare Provider Details

I. General information

NPI: 1619527371
Provider Name (Legal Business Name): PARKER DON TIMOTHY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 165
SANTA ROSA CA
95403-1675
US

IV. Provider business mailing address

3883 AIRWAY DR STE 165
SANTA ROSA CA
95403-1675
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7799
  • Fax:
Mailing address:
  • Phone: 707-521-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: