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General NPI Number Information
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NPI Number | 1003088972
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Entity Type | Individual
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Provider Name | PHILLIP PARKER CRACE MD FACS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 204 SERIO BLVD
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City | FERRIDAY
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State | LA
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Zip | 71334
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Country | US
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Telephone | 318-757-8010
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Fax | 318-757-9501
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Provider Business Mailing Address
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Address Line | 204 SERIO BLVD
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City | FERRIDAY
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State | LA
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Zip | 71334
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Country | US
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Telephone | 318-757-8010
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Fax | 318-757-9501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 41691
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD206664
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License Number State | LA
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