=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811948839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN PARKES, M.D. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 01/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 MEDICAL DR
-----------------------------------------------------
City | LAURINBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28352-5524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-277-9164
-----------------------------------------------------
Fax | 910-277-9189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 MEDICAL DR
-----------------------------------------------------
City | LAURINBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28352-5524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-277-9164
-----------------------------------------------------
Fax | 910-277-9189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN M PARKES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 910-277-9164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 39054
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------