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General NPI Number Information
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NPI Number | 1023306040
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Entity Type | Individual
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Provider Name | ADAM MAXWELL PARKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 12255 DEPAUL DRIVE SUITE 500
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-209-5180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-2551
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2011018542
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 2016015321
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License Number State | MO
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