DR. BRIAN DUKE PARK M.D. NPI 1508918616

NPI Information

NPI: 1508918616
Provider Name: DR. BRIAN DUKE PARK, M.D.
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

PECOS Registration: Yes

Address:
2725 CAPITOL AVE DEPT 402
SACRAMENTO, CA
ZIP 95816
Phone: (916) 262-9400
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DR. Brian Duke Park, M.D. is a vascular surgery surgery in Sacramento, CA with 20 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. DR. Brian Duke Park, M.D. NPI is 1508918616. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: HAHNEMANN UNIVERSITY COLLEGE OF MEDICINE
Graduation Year:2004

The provider's business location address is:

2725 CAPITOL AVE DEPT 402
SACRAMENTO, CA
ZIP 95816-032
Phone: (916) 262-9400
Fax: (916) 262-9399

The NPI 1508918616 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/17/2007 and was last updated on 1/18/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	A97247	CALIFORNIA	Yes
2	2086S0129X	Surgery	Vascular Surgery	ME 115350	FLORIDA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	14QW7	OTHER	FLORIDA	BLUE CROSS BLUE SHIELD
2	HJ868Z	MEDICARE PIN	FLORIDA
3	009175600	MEDICAID	FLORIDA
4	P01221852	MEDICARE PIN	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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