Provider Demographics
NPI:1841405495
Name:PARKER, BRIAN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:2B DEPT OF RADIOLOGY
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-389-3555
Mailing Address - Fax:715-389-7670
Practice Address - Street 1:1000 N OAK AVE
Practice Address - Street 2:2B DEPT OF RADIOLOGY
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-5703
Practice Address - Country:US
Practice Address - Phone:715-389-3555
Practice Address - Fax:715-389-7670
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI456212085R0202X
WI456210202085R0202X
MI43010826002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35308600Medicaid