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NPI Code Detail

MEDICARE: DR. BRENT D PARRY DPM

MEDICARE: DR. BRENT D PARRY DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist016004894IL
2213ES0103XFoot & Ankle Surgery Podiatrist016004894IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1016004894OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1891794004
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENT D PARRY DPM
Provider Business Mailing Address
First Line : 180 S MAIN ST
Second Line :
City : CANTON
State : IL
Zip : 61520-2608
Country : US
Telephone Number : 309-647-0201
Fax Number :
Provider Business Practice Location Address
First Line : 180 S MAIN ST
Second Line :
City : CANTON
State : IL
Zip : 61520-2608
Country : US
Telephone Number : 309-647-0201
Fax Number : 309-649-6880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 04/08/2021

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Directions to “ DR. BRENT D PARRY DPM” Practice Location

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