Healthcare Provider Details

I. General information

NPI: 1457345928
Provider Name (Legal Business Name): JOHN C PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SILVER STREAM LN
WILMINGTON NC
28401-7684
US

IV. Provider business mailing address

1500 PHYSICIANS DR
WILMINGTON NC
28401-7356
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3300
  • Fax: 910-815-2882
Mailing address:
  • Phone: 910-341-3300
  • Fax: 910-815-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number200100175
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: