Basic Information
| Provider Information | |||||||||
| NPI: | 1205085305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1191 BOWEN RD | ||||||||
| Address2: | |||||||||
| City: | ELMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140599546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166552690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 565 ABBOTT RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142202039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164795761 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2008 | ||||||||
| LastUpdateDate: | 08/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 254212 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000531879003 | 01 | NY | BLUE SHIELD WNY | OTHER | 03202288 | 05 | NY | MEDICAID | 0472629 | 01 | NY | INDEPENDENT HEALTH ASSOC | OTHER |