Provider Demographics
NPI:1174617716
Name:PARKER, MATTHEW N (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
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 1:50 MANNING PL
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1809
Mailing Address - Country:US
Mailing Address - Phone:205-995-4690
Mailing Address - Fax:205-995-4695
Practice Address - Street 1:50 MANNING PL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1809
Practice Address - Country:US
Practice Address - Phone:205-995-4690
Practice Address - Fax:205-995-4695
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL262082083P0500X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL26208OtherSTATE LICENSE NUMBER
AL515-31820OtherBLUE CROSS BLUE SHIELD
ALI25843Medicare UPIN