=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477646149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM PARKER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 01/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 W. MAIN ST.
-----------------------------------------------------
City | ILION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-895-2300
-----------------------------------------------------
Fax | 315-624-5152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9811 CAMPBELL RD
-----------------------------------------------------
City | SAUQUOIT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13456-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1471411
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------