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General NPI Number Information
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NPI Number | 1497416903
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Entity Type | Individual
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Provider Name | COLTON PARKER
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Gender | Male
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 2015 OCEAN DR STE 8
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5131
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Country | US
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Telephone | 561-737-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 1023 WATER TOWER WAY APT 207
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City | HYPOLUXO
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State | FL
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Zip | 33462-6246
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Country | US
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Telephone | 772-713-7404
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PAT9115419
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License Number State | FL
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