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NPI Code Detail

MEDICARE: DR. DERRICK OLIVER CLUNIS MD

MEDICARE: DR. DERRICK OLIVER CLUNIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME78560FL
2208M00000XHospitalist PhysicianME78560FL
3208000000XPediatrics Physician2021012259MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407832579
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DERRICK OLIVER CLUNIS MD
Provider Business Mailing Address
First Line : PO BOX 191
Second Line : PROVIDER ENROLLMENT DEPARTMENT
City : ROCKLAND
State : DE
Zip : 19732-0191
Country : US
Telephone Number : 302-651-6212
Fax Number : 302-651-4945
Provider Business Practice Location Address
First Line : 13535 NEMOURS PKWY
Second Line : NEMOURS CHILDRENS HOSPITAL
City : ORLANDO
State : FL
Zip : 32827-7402
Country : US
Telephone Number : 407-567-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 07/07/2021

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