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General NPI Number Information
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NPI Number | 1114213766
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Entity Type | Organization
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Legal Business Name | DAVE PARKER INC
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 1224 GREER AVE
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City | MARION
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State | VA
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Zip | 24354-4306
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Country | US
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Telephone | 276-920-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 GREER AVE
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City | MARION
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State | VA
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Zip | 24354-4306
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Country | US
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Telephone | 276-920-7242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID G PARKER
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Credential | DO
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Telephone | 276-962-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102201854
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License Number State | VA
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