Healthcare Provider Details

I. General information

NPI: 1750454864
Provider Name (Legal Business Name): A FREDERICK PARKER II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST WOUND CARE CENTER
JACKSON MS
39202-2064
US

IV. Provider business mailing address

1225 N STATE ST WOUND CARE CENTER
JACKSON MS
39202-2064
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1717
  • Fax: 601-944-9780
Mailing address:
  • Phone: 601-944-1717
  • Fax: 601-944-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number06450
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: