Provider Demographics
NPI:1548231392
Name:PARKER, CLIFF C
Entity type:Individual
Prefix:MR
First Name:CLIFF
Middle Name:C
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3115
Mailing Address - Country:US
Mailing Address - Phone:214-394-7296
Mailing Address - Fax:972-291-7340
Practice Address - Street 1:453 LEISURE DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3115
Practice Address - Country:US
Practice Address - Phone:214-394-7296
Practice Address - Fax:972-291-7340
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4593940001OtherSUPPLIER NUMBER