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General NPI Number Information
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NPI Number | 1467422402
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Entity Type | Individual
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Provider Name | JOSEPH PAUL DERVAY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | NASA JOHNSON SPACE CENTER FLIGHT MEDICINE CLINIC 2101 NASA ROAD ONE
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City | HOUSTON
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State | TX
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Zip | 77058
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Country | US
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Telephone | 281-483-7999
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Fax | 281-483-3392
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Provider Business Mailing Address
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Address Line | 4510 MASTERS DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-5805
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Country | US
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Telephone | 281-334-0223
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Fax | 281-334-0223
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | J6917
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | J6917
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | J6917
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License Number State | TX
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