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General NPI Number Information
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NPI Number | 1255361606
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Entity Type | Organization
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Legal Business Name | PARKER MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 6820 E BROWN RD
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City | MESA
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State | AZ
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Zip | 85207-3705
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Country | US
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Telephone | 480-924-9797
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Fax | 480-924-8508
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Provider Business Mailing Address
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Address Line | 6820 E BROWN RD
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City | MESA
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State | AZ
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Zip | 85207-3705
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Country | US
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Telephone | 480-924-9797
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Fax | 480-924-8508
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | MR. CLEVIS T. PARKER SR.
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Credential | M.D.
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Telephone | 480-924-9797
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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 | 34880
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License Number State | AZ
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