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General NPI Number Information
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NPI Number | 1194788554
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Entity Type | Individual
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Provider Name | DEREK LEE TOMES, MD MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3735 GLENLAKE DR
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City | CHARLOTTE
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State | NC
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Zip | 28208-6846
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Country | US
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Telephone | 704-749-5801
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SOAPSTONE CREEK RD
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City | ARDEN
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State | NC
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Zip | 28704-6542
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Country | US
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Telephone | 828-691-1175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | FT6518736
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License Number State | NC
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