John Richard Parker, PA-C
Physician Assistant in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1124100508
StatusActive
Last updated in NPPESFeb 25, 2021
Details
- NPI
- 1124100508
- Entity type
- Individual (NPI-1)
- Name
- John Richard Parker
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 19, 2006
- Certification date
- Feb 25, 2021
- Last updated
- Feb 25, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5601003563 | MI | Yes |
Practice location
4100 Lake Dr Se Ste 200Grand Rapids, MI 49546-8292
Phone 616-391-3759 · Fax 616-391-3052
Mailing address
100 Michigan St NeMc 845
Grand Rapids, MI 49503-2560
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