Healthcare Provider Details

I. General information

NPI: 1265051254
Provider Name (Legal Business Name): PAUL ROBERT PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST
BOSTON MA
02114-3096
US

IV. Provider business mailing address

1855 W TAYLOR ST RM 3.138
CHICAGO IL
60612-7242
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-3689
  • Fax: 617-573-6965
Mailing address:
  • Phone: 312-996-7774
  • Fax: 312-996-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1018587
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: