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General NPI Number Information
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NPI Number | 1790131779
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Entity Type | Individual
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Provider Name | LAITH DERBAS MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1055 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8468
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Country | US
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Telephone | 386-917-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 770 W GRANADA BLVD STE 101
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5179
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2016018870
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036.152637
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME171551
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License Number State | FL
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