Healthcare Provider Details

I. General information

NPI: 1891897435
Provider Name (Legal Business Name): JANET M. PARKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BANGOR ST STE 3
HOULTON ME
04730-1740
US

IV. Provider business mailing address

59 BANGOR ST STE 3
HOULTON ME
04730-1740
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-7161
  • Fax: 207-532-1090
Mailing address:
  • Phone: 207-532-7161
  • Fax: 207-532-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009206
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: