MEDICARE: WINFRED PARKER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	250	OK

General Provider Information

NPI Number	:	1255337226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINFRED PARKER PA

Provider Business Mailing Address
First Line	:	1044 SW 44TH ST
Second Line	:	STE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3611
Country	:	US
Telephone Number	:	405-631-4263
Fax Number	:	405-631-4820

Provider Business Practice Location Address
First Line	:	1044 SW 44TH ST
Second Line	:	STE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3611
Country	:	US
Telephone Number	:	405-631-4263
Fax Number	:	405-631-4820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/29/2007

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Directions to “ WINFRED PARKER PA” Practice Location

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