Healthcare Provider Details

I. General information

NPI: 1780260331
Provider Name (Legal Business Name): MARK JAMES PARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 E FLAMINGO AVE STE 200
NAMPA ID
83687-9300
US

IV. Provider business mailing address

4424 E FLAMINGO AVE STE 200
NAMPA ID
83687-9300
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-1400
  • Fax: 208-302-1455
Mailing address:
  • Phone: 208-302-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9871354
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: