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General NPI Number Information
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NPI Number | 1396992392
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Entity Type | Individual
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Provider Name | GERARD DERICKS MD
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Gender | Male
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 1498 SOLANO AVE
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City | ALBANY
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State | CA
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Zip | 94706-2148
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Country | US
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Telephone | 510-524-1680
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Fax | 510-528-8410
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Provider Business Mailing Address
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Address Line | 1498 SOLANO AVE
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City | ALBANY
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State | CA
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Zip | 94706-2148
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Country | US
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Telephone | 510-524-1680
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Fax | 510-528-8410
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G28626
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2486
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E6764
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License Number State | TX
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