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General NPI Number Information
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NPI Number | 1114137114
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Entity Type | Organization
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Legal Business Name | THOMAS J DERBES MD PA
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 2103 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4511
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Country | US
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Telephone | 850-913-8996
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Fax | 850-913-8956
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Provider Business Mailing Address
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Address Line | 2103 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4511
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Country | US
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Telephone | 850-913-8996
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Fax | 850-913-8956
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS JOSEPH DERBES
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Credential | M.D.
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Telephone | 850-913-8996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME48177
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License Number State | FL
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