Healthcare Provider Details

I. General information

NPI: 1750489092
Provider Name (Legal Business Name): GREGG SCOTT PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

18407 PINE FORREST RD
GULFPORT MS
39503-9055
US

V. Phone/Fax

Practice location:
  • Phone: 318-483-5057
  • Fax: 318-483-5029
Mailing address:
  • Phone: 601-364-7875
  • Fax: 601-364-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number07695
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number07695
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: