Healthcare Provider Details

I. General information

NPI: 1790974061
Provider Name (Legal Business Name): JEFFREY WRIGHT PARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E MAXWELL ST SUITE 202
LEXINGTON KY
40508-2678
US

IV. Provider business mailing address

125 E MAXWELL ST SUITE 202
LEXINGTON KY
40508-2678
US

V. Phone/Fax

Practice location:
  • Phone: 859-253-9200
  • Fax: 859-253-9966
Mailing address:
  • Phone: 859-253-9200
  • Fax: 859-253-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number25519
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: