Provider Demographics
NPI:1194885939
Name:CECIL L. PARKER, JR. MD, PC
Entity type:Organization
Organization Name:CECIL L. PARKER, JR. MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-470-0552
Mailing Address - Street 1:2866 DAUPHIN ST
Mailing Address - Street 2:SUITE V
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2486
Mailing Address - Country:US
Mailing Address - Phone:251-470-0552
Mailing Address - Fax:251-470-0896
Practice Address - Street 1:2866 DAUPHIN ST
Practice Address - Street 2:SUITE V
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2486
Practice Address - Country:US
Practice Address - Phone:251-470-0552
Practice Address - Fax:251-470-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015675Medicaid
AL000015675Medicaid
AL51015675Medicare ID - Type Unspecified