Provider Demographics
NPI:1285194134
Name:PARKER, BRENT EARL JR (ATP)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:EARL
Last Name:PARKER
Suffix:JR
Gender:
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S WOODRUFF AVE STE B10
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4866
Mailing Address - Country:US
Mailing Address - Phone:208-553-7805
Mailing Address - Fax:
Practice Address - Street 1:211 S WOODRUFF AVE STE B10
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4866
Practice Address - Country:US
Practice Address - Phone:208-553-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3586332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment