Healthcare Provider Details

I. General information

NPI: 1609803873
Provider Name (Legal Business Name): JULIAN PARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ARGILLITE RD
FLATWOODS KY
41139-1972
US

IV. Provider business mailing address

641 KENWOOD DR
RUSSELL KY
41169-1519
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-3600
  • Fax: 606-836-0205
Mailing address:
  • Phone: 606-833-8596
  • Fax: 606-836-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37161
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: