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General NPI Number Information
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NPI Number | 1700850500
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Entity Type | Individual
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Provider Name | DERRALL SHAWN PARKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 07/03/2014
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Provider Practice Location Address
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Address Line | 360 S MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4920
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Country | US
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Telephone | 573-335-3577
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Fax | 573-335-1559
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Provider Business Mailing Address
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Address Line | 360 S MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4920
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Country | US
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Telephone | 573-335-3577
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Fax | 573-335-1559
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | KY30522
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD116562
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036-101500
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License Number State | MO
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