Provider Demographics
NPI:1992881015
Name:PARKER, JAMES T (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
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:PO BOX 779
Mailing Address - Street 2:CHANNEL MEDICAL CENTER
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-0779
Mailing Address - Country:US
Mailing Address - Phone:209-944-4700
Mailing Address - Fax:209-944-4795
Practice Address - Street 1:701 E CHANNEL ST
Practice Address - Street 2:CHANNEL MEDICAL CENTER
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2628
Practice Address - Country:US
Practice Address - Phone:209-944-4700
Practice Address - Fax:209-944-4795
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG047763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE63846Medicare UPIN