# R JEFFREY PARKER MD A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Retina Consultants of Southern Utah
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669410098
- **Authorized official:** AMY GRIM (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (702) 202-4776

## Contact information

- **Practice address:** 1791 E 280 N, ST GEORGE, UT 84790-2400
- **Practice address phone:** (702) 369-0200
- **Practice address fax:** (702) 243-8383
- **Mailing address:** 3006 S MARYLAND PARKWAY, SUITE 710, LAS VEGAS, NV 89109
- **Mailing address phone:** (702) 369-0200
- **Mailing address fax:** (702) 243-8383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 963214201205 | UT | Yes |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 03/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 530401246018 | — | UT |