Basic Information
| Provider Information | |||||||||
| NPI: | 1497416903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | COLTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1023 WATER TOWER WAY APT 207 | ||||||||
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| City: | HYPOLUXO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727137404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2015 OCEAN DR STE 8 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334265131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617374777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2022 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PAT9115419 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.