Healthcare Provider Details

I. General information

NPI: 1699716886
Provider Name (Legal Business Name): GERALD B. PARKER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 EMMAUS RD
TYRONE PA
16686-9446
US

IV. Provider business mailing address

164 EMMAUS RD
TYRONE PA
16686-9446
US

V. Phone/Fax

Practice location:
  • Phone: 484-868-3910
  • Fax:
Mailing address:
  • Phone: 484-868-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05577100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: