Individual
BRIAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-2200
(619) 532-6400
Mailing address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101275953
VA
208D00000X
General Practice Physician
Primary
0101275953
VA
Other
Enumeration date
06/10/2019
Last updated
08/04/2025
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