Healthcare Provider Details

I. General information

NPI: 1689177743
Provider Name (Legal Business Name): ALEXANDER GAYLE PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-1000
  • Fax:
Mailing address:
  • Phone: 636-933-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2021047265
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: