Healthcare Provider Details

I. General information

NPI: 1073134144
Provider Name (Legal Business Name): PARKER THOMAS RICHARDSON CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

PO BOX 248846
OKLAHOMA CITY OK
73124-8846
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-9641
  • Fax: 405-235-0738
Mailing address:
  • Phone: 800-475-6236
  • Fax: 706-653-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number31
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: