Provider Demographics
NPI:1992763379
Name:PARKER, OWEN STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:OWEN
Middle Name:STANLEY
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OWEN
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6476 S STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-9473
Mailing Address - Country:US
Mailing Address - Phone:830-456-6460
Mailing Address - Fax:
Practice Address - Street 1:6476 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-9473
Practice Address - Country:US
Practice Address - Phone:830-456-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4033207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139503030Medicaid
TX8L20064Medicare PIN
TX8L18962Medicare PIN
TX139503030Medicaid