Healthcare Provider Details

I. General information

NPI: 1053387431
Provider Name (Legal Business Name): MARK A PARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 BIEHN STREET
KLAMATH FALLS OR
97601
US

IV. Provider business mailing address

444 NW ELKS DR
CORVALLIS OR
97330-3745
US

V. Phone/Fax

Practice location:
  • Phone: 541-205-6890
  • Fax: 541-205-6899
Mailing address:
  • Phone: 541-205-6890
  • Fax: 541-205-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036088889
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG87495
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD182488
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: