Healthcare Provider Details

I. General information

NPI: 1881671733
Provider Name (Legal Business Name): DAVID L PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 RIVERSIDE AVE MAIL STOP 31700A - HEALTHPARTNERS RIVERSIDE CLINIC
MINNEAPOLIS MN
55454-1321
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 612-341-5000
  • Fax: 612-371-1673
Mailing address:
  • Phone: 952-883-5375
  • Fax: 612-371-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number30630
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: