Healthcare Provider Details

I. General information

NPI: 1205246790
Provider Name (Legal Business Name): DEREK PARKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 A ST NE STE 9
LINTON IN
47441-1612
US

IV. Provider business mailing address

1600 A ST NE STE 9
LINTON IN
47441-1612
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-7005
  • Fax: 812-847-5309
Mailing address:
  • Phone: 812-847-7005
  • Fax: 812-847-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTRN19911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01078030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: