Provider Demographics
NPI:1730529553
Name:PARKINSON, JUSTIN LOREN (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LOREN
Last Name:PARKINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-6500
Mailing Address - Fax:208-302-6535
Practice Address - Street 1:757 E WYTHE CREEK CT
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5006
Practice Address - Country:US
Practice Address - Phone:208-302-6500
Practice Address - Fax:208-302-6535
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine