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Individual

DR. BRIAN DUKE PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2725 CAPITOL AVE DEPT 402, SACRAMENTO, CA 95816-6032
(916) 262-9400
(916) 262-9399
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
A97247
CA
2086S0129X
Vascular Surgery Physician
ME 115350
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009175600
FL
01
14QW7
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/17/2007
Last updated
01/18/2017
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