Healthcare Provider Details

I. General information

NPI: 1598883522
Provider Name (Legal Business Name): JASON PARKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4429
  • Fax: 727-767-8526
Mailing address:
  • Phone: 727-767-4429
  • Fax: 727-767-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberOS13811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: