Provider Demographics
NPI:1902243876
Name:PARKER, VICTOR D III (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:D
Last Name:PARKER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WHITEMAN AFB
Mailing Address - Street 2:509 SIJAN AVENUE
Mailing Address - City:KNOBNOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509TH MEDICAL GROUP SGHC
Practice Address - Street 2:331 SIJAN AVENUE
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65035
Practice Address - Country:US
Practice Address - Phone:660-687-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460001171000000X
GA81145208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA81145OtherGENERAL PRACTICE