MEDICARE: JOHN S DERBYSHIRE MD

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
1	207R00000X	Internal Medicine Physician	20782	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196944	OTHER	NC	CIGNA HEALTHCARE
2	28356	OTHER	NC	BCBSNC
3	22965	OTHER	NC	MEDCOST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275527905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN S DERBYSHIRE MD

Provider Business Mailing Address
First Line	:	1051 COUNTRY CLUB RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1710
Country	:	US
Telephone Number	:	252-937-4084
Fax Number	:	252-937-7538

Provider Business Practice Location Address
First Line	:	1051 COUNTRY CLUB RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1710
Country	:	US
Telephone Number	:	252-937-4084
Fax Number	:	252-937-7538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2007

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