Healthcare Provider Details

I. General information

NPI: 1790780476
Provider Name (Legal Business Name): WESLEY A. PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIOUX VALLEY DR
CHEROKEE IA
51012-1205
US

IV. Provider business mailing address

300 SIOUX VALLEY DR
CHEROKEE IA
51012-1205
US

V. Phone/Fax

Practice location:
  • Phone: 712-225-6265
  • Fax: 712-225-6800
Mailing address:
  • Phone: 712-225-6265
  • Fax: 712-225-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26274
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: