Healthcare Provider Details

I. General information

NPI: 1376704346
Provider Name (Legal Business Name): DEREK ALEXANDRE RAPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2008
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 GEORGE BUSH HWY SUITE 101
RICHARDSON TX
75082-3566
US

IV. Provider business mailing address

3201 GEORGE BUSH HWY SUITE 101
RICHARDSON TX
75082-3566
US

V. Phone/Fax

Practice location:
  • Phone: 972-470-5004
  • Fax: 972-470-5007
Mailing address:
  • Phone: 972-470-5004
  • Fax: 972-470-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number236903
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301094368
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberQ9487
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberQ9487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: