Healthcare Provider Details

I. General information

NPI: 1013505684
Provider Name (Legal Business Name): DEREK TITUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE WASHINGTON ST PULLMAN WA 99164
PULLMAN WA
99164-0001
US

IV. Provider business mailing address

624 E FRONT AVE
SPOKANE WA
99202-2139
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.OP.70131936
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: