Healthcare Provider Details

I. General information

NPI: 1649229097
Provider Name (Legal Business Name): DENNIS MATTHEW PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY #660
OKC OK
73112-4416
US

IV. Provider business mailing address

3366 NW EXPRESSWAY #660
OKC OK
73112-4416
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-3345
  • Fax: 405-949-0849
Mailing address:
  • Phone: 405-947-3345
  • Fax: 405-949-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number13570
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: