MEDICARE: LACEY PERRIN PARKER M.D,

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	207L00000X	Anesthesiology Physician	E-9068	AR

General Provider Information

NPI Number	:	1306130208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY PERRIN PARKER M.D,

Provider Business Mailing Address
First Line	:	1116 KAVANAUGH BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4318
Country	:	US
Telephone Number	:	501-650-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E MATTHEWS AVE
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4314
Country	:	US
Telephone Number	:	870-935-8500
Fax Number	:

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

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	10/09/2015

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