Provider Demographics
NPI:1902872633
Name:PARKER, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:PARKER
Suffix:
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 1:100 EIGHTH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389
Mailing Address - Country:US
Mailing Address - Phone:636-668-6824
Mailing Address - Fax:
Practice Address - Street 1:100 EIGHTH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389
Practice Address - Country:US
Practice Address - Phone:636-668-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
967355318OtherMEDICARE PTAN CMS
G59893Medicare UPIN