Healthcare Provider Details

I. General information

NPI: 1902508674
Provider Name (Legal Business Name): PARKER WINFIELD LEMON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 E PONY EXPRESS PKWY STE 1
EAGLE MOUNTAIN UT
84005-5531
US

IV. Provider business mailing address

3100 CHANNING WAY
IDAHO FALLS ID
83404-7533
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-8037
  • Fax: 801-753-7476
Mailing address:
  • Phone: 208-973-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14277751-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: