Healthcare Provider Details

I. General information

NPI: 1003055815
Provider Name (Legal Business Name): DEREK RINGERS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 OSLOSKI RD
EUREKA MT
59917-9217
US

IV. Provider business mailing address

PO BOX 31001-4110
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-3145
  • Fax: 406-297-3364
Mailing address:
  • Phone: 63-271-7504
  • Fax: 406-327-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5084
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003928
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number79185
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: