Healthcare Provider Details

I. General information

NPI: 1699477398
Provider Name (Legal Business Name): DEREK ENEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W HIGHLAND BLVD
INVERNESS FL
34452-4720
US

IV. Provider business mailing address

502 W HIGHLAND BLVD
INVERNESS FL
34452-4720
US

V. Phone/Fax

Practice location:
  • Phone: 352-446-6987
  • Fax:
Mailing address:
  • Phone: 352-697-3581
  • Fax: 352-446-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberW2498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: