=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306933965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL CRAIG PARKER, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E FAIRWAY DR SUITE 402
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-893-1070
-----------------------------------------------------
Fax | 985-893-1083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E FAIRWAY DR SUITE 402
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-893-1070
-----------------------------------------------------
Fax | 985-893-1083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGERT
-----------------------------------------------------
Name | MRS. DIANE LYNN WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-893-1070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 015828
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------