Healthcare Provider Details

I. General information

NPI: 1841489820
Provider Name (Legal Business Name): DERRICK DEAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLE CHASSE HWY
TERRYTOWN LA
70056-7127
US

IV. Provider business mailing address

3439 PRYTANIA ST STE 501
NEW ORLEANS LA
70115-7905
US

V. Phone/Fax

Practice location:
  • Phone: 800-893-9698
  • Fax:
Mailing address:
  • Phone: 504-635-2604
  • Fax: 504-304-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number110
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDO.000110
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: