Provider Demographics
NPI:1194715839
Name:PARKER, ROBERT LAMAR JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAMAR
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4075
Mailing Address - Country:US
Mailing Address - Phone:336-765-9350
Mailing Address - Fax:336-760-4255
Practice Address - Street 1:2927 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4005
Practice Address - Country:US
Practice Address - Phone:336-765-9350
Practice Address - Fax:336-760-4255
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC65342OtherBCBS
NC8965342Medicaid
NC8965342Medicaid
NC209411Medicare PIN
NCC89390Medicare UPIN
NC209411BMedicare PIN