Provider Demographics
NPI:1194740597
Name:PARKER, DAVID R JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:4541 N JOSEY LN STE 110
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4622
Mailing Address - Country:US
Mailing Address - Phone:469-788-8588
Mailing Address - Fax:469-788-7800
Practice Address - Street 1:4541 N JOSEY LN STE 110
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4622
Practice Address - Country:US
Practice Address - Phone:469-788-8588
Practice Address - Fax:469-788-7800
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3136208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118728807Medicaid
TX118728802Medicaid
TX118728804Medicaid
TXTXB121527Medicare PIN
TXC20215Medicare UPIN
TX118728804Medicaid
TXTXB121646Medicare PIN
TX8D8485Medicare ID - Type Unspecified
TXTXB121638Medicare PIN