Healthcare Provider Details

I. General information

NPI: 1902872633
Provider Name (Legal Business Name): DANIEL R PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EIGHTH STREET SUITE 2
WINFIELD MO
63389
US

IV. Provider business mailing address

100 EIGHTH STREET SUITE 2
WINFIELD MO
63389
US

V. Phone/Fax

Practice location:
  • Phone: 636-668-6824
  • Fax:
Mailing address:
  • Phone: 636-668-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1999134573
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: