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Individual
DR. JACOB C. PARKER
Active
Individual
DR. JACOB C. PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO, MD
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
8420042213
IL
163WC0400X
Case Management Registered Nurse
MS80885
MS
246Z00000X
Other Specialist/Technologist
800341120
HI
246Z00000X
Other Specialist/Technologist
Primary
800341120
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251123217211
CLIA LICENSES
MS
01
—
25187411
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS
MS
05
—
314125401870
—
MS
05
—
7NQ3-KD9-CK19
—
MS
05
—
800341120
—
MS
01
—
MS80885
MEDICAL LICENSES
MS
Enumeration date
12/24/2018
Last updated
11/11/2025
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