Healthcare Provider Details

I. General information

NPI: 1710972013
Provider Name (Legal Business Name): RICHARD LEE PARKER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PARK AVENUE
COHOCTON NY
14826-9401
US

IV. Provider business mailing address

10869 STATE ROUTE 36
DANSVILLE NY
14437-9444
US

V. Phone/Fax

Practice location:
  • Phone: 585-384-5310
  • Fax: 585-384-9864
Mailing address:
  • Phone: 585-335-3100
  • Fax: 585-335-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number249809
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00025962
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: