Healthcare Provider Details

I. General information

NPI: 1073207478
Provider Name (Legal Business Name): LEROY PARKER IV PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 VETERANS MEMORIAL DR STE 101
ABBEVILLE LA
70510-4152
US

IV. Provider business mailing address

3013 VETERANS MEMORIAL DR STE 101
ABBEVILLE LA
70510-4152
US

V. Phone/Fax

Practice location:
  • Phone: 337-893-2273
  • Fax: 337-385-5009
Mailing address:
  • Phone: 337-893-2273
  • Fax: 337-385-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number344748
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: