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General NPI Number Information
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NPI Number | 1235370156
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Entity Type | Individual
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Provider Name | MR. EDWARD HENRY PARKER
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Gender | Male
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4715 VALLEY EAST BLVD SUITE 3
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City | ARCATA
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State | CA
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Zip | 95521-3584
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Country | US
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Telephone | 707-822-3376
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Fax | 707-822-5053
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Provider Business Mailing Address
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Address Line | 1575 S RAILROAD AVE
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City | CRESCENT CITY
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State | CA
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Zip | 95531-6821
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Country | US
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Telephone | 707-464-8335
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Fax | 707-464-8339
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13679
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License Number State | CA
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