Provider Demographics
NPI:1376869396
Name:PARKS, BRIAN NICHOLAS (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:NICHOLAS
Last Name:PARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MEDICAL DR STE 208
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3106
Mailing Address - Country:US
Mailing Address - Phone:361-574-1137
Mailing Address - Fax:361-574-1186
Practice Address - Street 1:115 MEDICAL DR STE 208
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3106
Practice Address - Country:US
Practice Address - Phone:361-574-1137
Practice Address - Fax:361-574-1186
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036141626207LP2900X
MIL1761511207R00000X
OK5699208VP0014X
390200000X
TXQ6891207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program