Provider Demographics
NPI:1578525382
Name:PARKER, CLEVIS T SR (MD)
Entity type:Individual
Prefix:
First Name:CLEVIS
Middle Name:T
Last Name:PARKER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5990 VISCAYA GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2883
Mailing Address - Country:US
Mailing Address - Phone:325-513-5778
Mailing Address - Fax:
Practice Address - Street 1:1665 ANTILLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5271
Practice Address - Country:US
Practice Address - Phone:325-793-5350
Practice Address - Fax:325-793-5354
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34880207Q00000X
NV17763207Q00000X, 207QH0002X
TXN7737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBP6953384OtherDEA
LA4A736DH01Medicare PIN
AZBP6953384OtherDEA