Healthcare Provider Details

I. General information

NPI: 1629178108
Provider Name (Legal Business Name): BERNIE P PARRISH II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 E SUNSHINE ST
SPRINGFIELD MO
65804-2047
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-1922
  • Fax: 417-269-1930
Mailing address:
  • Phone: 417-269-1922
  • Fax: 417-269-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR5P17
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: