Provider Demographics
NPI:1861429086
Name:PARKER, TIMOTHY JAMES (DMD PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:PARKER
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4427
Mailing Address - Country:US
Mailing Address - Phone:904-737-3263
Mailing Address - Fax:904-448-5301
Practice Address - Street 1:8351 BAYBERRY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4427
Practice Address - Country:US
Practice Address - Phone:904-737-3263
Practice Address - Fax:904-448-5301
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00109571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67637Medicare ID - Type Unspecified
T54934Medicare UPIN