Healthcare Provider Details

I. General information

NPI: 1750347720
Provider Name (Legal Business Name): JEFFREY ALAN PARKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 CENTER POINT RD NE STE A
CEDAR RAPIDS IA
52402-4064
US

IV. Provider business mailing address

3047 CENTER POINT RD NE STE A
CEDAR RAPIDS IA
52402-4064
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-6973
  • Fax: 319-365-6974
Mailing address:
  • Phone: 319-365-6973
  • Fax: 319-365-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00733
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0433086
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: