Basic Information
| Provider Information | |||||||||
| NPI: | 1205246790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKES | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 A ST NE STE 9 | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474411612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128477005 | ||||||||
| FaxNumber: | 8128475309 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 A ST NE STE 9 | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474411612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128477005 | ||||||||
| FaxNumber: | 8128475309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TRN19911 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01078030A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01078030A | 01 | IN | INDIANA MEDICAL LICENSE | OTHER | FP5531769 | 01 | DEA | OTHER | TRN19911 | 01 | FL | FLORIDA RESIDENT TRAINING LICENSE | OTHER |