MEDICARE: PETER J 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	207KA0200X	Allergy Physician	A44924	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598783789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J PARKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5108
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91221-2108
Country	:	US
Telephone Number	:	310-276-2400
Fax Number	:	310-276-4634

Provider Business Practice Location Address
First Line	:	1100 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2606
Country	:	US
Telephone Number	:	818-546-2626
Fax Number	:	818-546-1056

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/06/2022

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