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General NPI Number Information
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NPI Number | 1740819754
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Entity Type | Individual
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Provider Name | DEREK CASEY
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 407 SE 9TH ST STE 106
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1113
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Country | US
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Telephone | 549-463-0112
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Fax | 954-463-0117
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Provider Business Mailing Address
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Address Line | 2633 NW 48TH ST
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City | BOCA RATON
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State | FL
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Zip | 33434-2586
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | OS19961
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License Number State | FL
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