Healthcare Provider Details

I. General information

NPI: 1093150773
Provider Name (Legal Business Name): DEREK BATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST # MS 47
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

300 PINELLAS ST # MS 47
CLEARWATER FL
33756-3804
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-7907
  • Fax: 727-462-7904
Mailing address:
  • Phone: 727-462-7907
  • Fax: 727-462-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017012768
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26423
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2017-0750
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME153738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: