Basic Information
| Provider Information | |||||||||
| NPI: | 1033103189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1317 4TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054585000 | ||||||||
| FaxNumber: | 2054585005 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 4TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054585000 | ||||||||
| FaxNumber: | 2054585005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 02/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 22946 | AL | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00351254 | 01 | AL | RAILROAD MEDICARE | OTHER |