Provider Demographics
NPI:1871983668
Name:PARKER, TIMOTHY GRANT JR
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GRANT
Last Name:PARKER
Suffix:JR
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 1:31ST MEU
Mailing Address - Street 2:UNIT 35621
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96385-5621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL OKINAWA
Practice Address - Street 2:CAMP FOSTER
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362
Practice Address - Country:US
Practice Address - Phone:098-971-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101260843207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program