Healthcare Provider Details

I. General information

NPI: 1477646149
Provider Name (Legal Business Name): WILLIAM PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W. MAIN ST.
ILION NY
13357
US

IV. Provider business mailing address

9811 CAMPBELL RD
SAUQUOIT NY
13456-3005
US

V. Phone/Fax

Practice location:
  • Phone: 315-895-2300
  • Fax: 315-624-5152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1471411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: