MEDICARE: DR. EDSON OLIVER PARKER III 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	5322	NV
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	5322	NV
3	208VP0014X	Interventional Pain Medicine Physician	5322	NV

General Provider Information

NPI Number	:	1598935900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDSON OLIVER PARKER III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 29209
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-3209
Country	:	US
Telephone Number	:	702-499-9994
Fax Number	:	702-474-9420

Provider Business Practice Location Address
First Line	:	3131 LA CANADA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2578
Country	:	US
Telephone Number	:	702-303-2416
Fax Number	:	702-474-9420

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	07/06/2009

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