Healthcare Provider Details

I. General information

NPI: 1396108007
Provider Name (Legal Business Name): DERRICK DREW TRUMP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 U S HIGHWAY 49
HATTIESBURG MS
39401-7200
US

IV. Provider business mailing address

107 MONARCH BLVD
HATTIESBURG MS
39402-7203
US

V. Phone/Fax

Practice location:
  • Phone: 601-288-7000
  • Fax:
Mailing address:
  • Phone: 304-575-1268
  • Fax:

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 TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMS26109
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT-3227
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: