Healthcare Provider Details

I. General information

NPI: 1609914902
Provider Name (Legal Business Name): WAYLON MORRIS PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 HIGHWAY 10 VILLA FELICIANA MEDICAL COMPLEX
JACKSON LA
70748
US

IV. Provider business mailing address

5635 MAIN STREET SUITE A #222
ZACHARY LA
70791
US

V. Phone/Fax

Practice location:
  • Phone: 225-634-4079
  • Fax:
Mailing address:
  • Phone: 225-634-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number016672
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number016672
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: