Healthcare Provider Details

I. General information

NPI: 1023306040
Provider Name (Legal Business Name): ADAM MAXWELL PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DEPAUL DRIVE SUITE 500
BRIDGETON MO
63044
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-2551
US

V. Phone/Fax

Practice location:
  • Phone: 314-209-5180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2011018542
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2016015321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: