Basic Information
| Provider Information | |||||||||
| NPI: | 1861491920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARRISH | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 612 N HIGH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HENDERSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756525914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036571441 | ||||||||
| FaxNumber: | 9036551442 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 NACOGDOCHES ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757662462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035866289 | ||||||||
| FaxNumber: | 9035890748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 04/19/2011 | ||||||||
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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 | 207X00000X | J7829 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | BP8788905 | 01 | TX | DEA | OTHER | 0857690-01 | 01 | TX | MCD GROUP | OTHER | CC8386 | 01 | TX | RR MCR GROUP | OTHER | 1040350 | 01 | TX | BLUE LINK | OTHER | 166974901 | 05 | TX | MEDICAID | P00199785 | 01 | TX | RR MCR | OTHER | 00U762 | 01 | TX | MCR GROUP | OTHER |