Provider Demographics
NPI:1952493223
Name:PARKER, BRIAN JUEL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JUEL
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9499 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-240-9500
Mailing Address - Fax:702-933-6789
Practice Address - Street 1:9499 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-240-9500
Practice Address - Fax:702-933-6789
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8727208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV5366OtherBLUE CROSS BLUE SHIELD
NVNV5366OtherBLUE CROSS BLUE SHIELD
H00920Medicare UPIN