Individual
MICHELLE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5414 S BROADWAY AVE, TYLER, TX 75703-1335
(903) 581-1601
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q2480
TX
207Q00000X
Family Medicine Physician
BP10046115
TX
207Q00000X
Family Medicine Physician
Q2480
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34563511
—
TX
05
—
345653510
—
TX
01
—
861757
MEDICARE
TX
01
—
861895
MEDICARE
TX
01
—
8FK760
BCBS
TX
01
—
8FK761
BCBS
TX
01
—
8LH675
BCBS
TX
01
—
P01584101
RAIL ROAD MEDICARE
TX
01
—
P01587389
RAIL ROAD MEDICARE
TX
Enumeration date
06/05/2013
Last updated
12/28/2023
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