Healthcare Provider Details

I. General information

NPI: 1811936453
Provider Name (Legal Business Name): HEATH A. PARKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7708 LOHMAN FORD ROAD SUITE 101
LAGO VISTA TX
78645-4781
US

IV. Provider business mailing address

7708 LOHMAN FORD ROAD SUITE 101
LAGO VISTA TX
78645-4781
US

V. Phone/Fax

Practice location:
  • Phone: 512-267-1877
  • Fax:
Mailing address:
  • Phone: 512-267-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK6902
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO 1572
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK6902
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberDO 1572
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1572
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: