Basic Information
| Provider Information | |||||||||
| NPI: | 1588699342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | EMERY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 876196 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996876196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073570820 | ||||||||
| FaxNumber: | 9073570821 | ||||||||
| Practice Location | |||||||||
| Address1: | 17025 SNOWMOBILE LN | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995777044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076949553 | ||||||||
| FaxNumber: | 9076949585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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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 | 207Q00000X | 4301083089 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 6631 | AK | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD6631 | 05 | AK | MEDICAID | 11301089 | 01 | CAQH PROVIDER ID | OTHER | 4607826 | 05 | MI | MEDICAID | 086910171 | 01 | MI | BCBSM PROVIDER NUMBER | OTHER | 381303843 | 01 | TAX ID | OTHER |