Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 17763 | NV |
N | 207Q00000X | Family Doctor | 34880 | AZ |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 17763 | NV |
NPI | 1578525382 |
---|---|
Provider Name | Clevis T. Parker SR. |
First Address | Las Vegas, NV 89134-6299 |
Second Address | Las Vegas, NV 89121-3959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 19/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H48849 | (02) |