1467480202 NPI number — CLAUDE JACKSON PARKER III MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467480202 NPI number — CLAUDE JACKSON PARKER III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
CLAUDE
Provider Middle Name:
JACKSON
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
C. JACK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467480202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5127 S ORANGE AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32809-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-841-1491
Provider Business Mailing Address Fax Number:
407-841-1493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5127 S ORANGE AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-841-1491
Provider Business Practice Location Address Fax Number:
407-841-1493
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME50072 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180027261 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 049443300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014605000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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