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General NPI Number Information
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NPI Number | 1538241799
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Entity Type | Individual
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Provider Name | DEREK TED EARL D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 600 NW 11TH ST SUITE E-15
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City | HERMISTON
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State | OR
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Zip | 97838-8602
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Country | US
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Telephone | 541-567-6434
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Fax | 541-567-6019
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Provider Business Mailing Address
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Address Line | 151 NE 12TH ST
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City | HERMISTON
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State | OR
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Zip | 97838-2598
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Country | US
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Telephone | 541-567-3643
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Fax | 541-567-6019
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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 | OP00001751
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO23298
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License Number State | OR
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