Healthcare Provider Details

I. General information

NPI: 1386321388
Provider Name (Legal Business Name): EMMANUEL PARKER AFARI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 03/22/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D.L. INGRAM AVENUE, BLG 1408
CANNON AFB NM
88103
US

IV. Provider business mailing address

27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D.L. INGRAM AVENUE, BLG 1408
CANNON AFB NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: