Healthcare Provider Details

I. General information

NPI: 1811994593
Provider Name (Legal Business Name): PAUL J. PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BURNETT CT
RICHMOND VT
05477-4410
US

IV. Provider business mailing address

12 BURNETT CT
RICHMOND VT
05477-4410
US

V. Phone/Fax

Practice location:
  • Phone: 802-434-5090
  • Fax: 802-329-2144
Mailing address:
  • Phone: 802-434-5090
  • Fax: 802-329-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0009376
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: