MEDICARE: DR. MARY VIRGINIA 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	2086S0129X	Vascular Surgery Physician	35794	CO

General Provider Information

NPI Number	:	1477543478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY VIRGINIA PARKER M.D.

Provider Business Mailing Address
First Line	:	7102 BETHENCOURT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3407
Country	:	US
Telephone Number	:	210-822-3360
Fax Number	:

Provider Business Practice Location Address
First Line	:	BROOKE ARMY MEDICAL CENTER
Second Line	:	3851 ROGER BROOKE DRIVE
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-6200
Country	:	US
Telephone Number	:	210-916-1174
Fax Number	:	210-916-0855

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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