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General NPI Number Information
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NPI Number | 1376869396
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Entity Type | Individual
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Provider Name | BRIAN NICHOLAS PARKS D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 115 MEDICAL DR STE 208
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City | VICTORIA
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State | TX
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Zip | 77904-3106
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Country | US
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Telephone | 361-574-1137
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Fax | 361-574-1186
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Provider Business Mailing Address
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Address Line | 115 MEDICAL DR STE 208
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City | VICTORIA
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State | TX
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Zip | 77904-3106
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Country | US
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Telephone | 361-574-1137
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Fax | 361-574-1186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036141626
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L1761511
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 5699
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | Q6891
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License Number State | TX
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