MEDICARE: DR. PHILIP SCOTT PARKER PH.D., HSPP

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	103TC0700X	Clinical Psychologist	20041153A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000207576	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1487662565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP SCOTT PARKER PH.D., HSPP

Provider Business Mailing Address
First Line	:	8135 BRENT AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-2725
Country	:	US
Telephone Number	:	317-650-1105
Fax Number	:	317-726-0714

Provider Business Practice Location Address
First Line	:	8135 BRENT AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-2725
Country	:	US
Telephone Number	:	317-650-1105
Fax Number	:	317-726-0714

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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