Provider Demographics
NPI:1992815435
Name:ESTVOLD, PARKER GENE (MD)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:GENE
Last Name:ESTVOLD
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 1:2300 OLD MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:FL
Mailing Address - Zip Code:32531-8518
Mailing Address - Country:US
Mailing Address - Phone:251-368-9136
Mailing Address - Fax:251-368-0832
Practice Address - Street 1:5811 JACK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-5025
Practice Address - Country:US
Practice Address - Phone:251-368-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL23316OtherSTATE LICENSE
WA37487OtherSTATE LICENSE
AL631900009Medicaid
FLME0033799OtherSTATE LICENSE
AL23316OtherSTATE LICENSE