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General NPI Number Information
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NPI Number | 1407850498
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Entity Type | Individual
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Provider Name | LOUIS DEROUCHEY MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 475 BRUCE ST STE 500
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City | YREKA
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State | CA
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Zip | 96097-3463
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Country | US
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Telephone | 530-842-3507
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Fax | 530-842-9054
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Provider Business Mailing Address
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Address Line | PO BOX 1126
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City | YREKA
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State | CA
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Zip | 96097-1126
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Country | US
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Telephone | 530-842-3507
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Fax | 530-842-9054
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A47801
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License Number State | CA
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