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General NPI Number Information
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NPI Number | 1609914902
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Entity Type | Individual
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Provider Name | WAYLON MORRIS PARKER MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 5002 HIGHWAY 10 VILLA FELICIANA MEDICAL COMPLEX
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City | JACKSON
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State | LA
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Zip | 70748
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Country | US
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Telephone | 225-634-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 5635 MAIN STREET SUITE A #222
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City | ZACHARY
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State | LA
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Zip | 70791
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Country | US
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Telephone | 225-634-4079
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 016672
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 016672
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License Number State | LA
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