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NPI Code Detail

MEDICARE: DERRICK EDDIE

MEDICARE: DERRICK EDDIE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1023442639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK EDDIE
Provider Business Mailing Address
First Line : 5420 W SAHARA AVE STE 201
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-0389
Country : US
Telephone Number : 702-882-7827
Fax Number :
Provider Business Practice Location Address
First Line : 5420 W SAHARA AVE STE 201
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-0389
Country : US
Telephone Number : 702-882-7827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2013
Last Update Date : 08/30/2013

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Directions to “ DERRICK EDDIE ” Practice Location

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