Individual
DR. LAVAN R PARKER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6501 BLANCO RD, SAN ANTONIO, TX 78216
(210) 341-7264
(210) 341-2022
Mailing address
6501 BLANCO RD, SAN ANTONIO, TX 78216
(210) 341-7264
(210) 341-2022
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17827
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151926601
—
TX
05
—
151926602
—
TX
05
—
151926603
—
TX
05
—
151926605
—
TX
05
—
151926606
—
TX
05
—
151926607
—
TX
05
—
151926608
—
TX
01
—
731009960006
TRICARE
—
01
—
80W704
BCBS
—
01
—
838355
UNITED CONCORDIA
—
01
—
P00147516
RAILROAD MEDICARE
—
Enumeration date
01/13/2006
Last updated
01/26/2011
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