Provider Demographics
NPI:1699901033
Name:PARKER, MATTHEW CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARROLL
Last Name:PARKER
Suffix:
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 1:4800 NE STALLINGS DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1249
Mailing Address - Country:US
Mailing Address - Phone:936-564-7383
Mailing Address - Fax:936-569-0374
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-564-7383
Practice Address - Fax:936-569-0549
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine