MEDICARE: DR. JOSEPH PAUL DERVAY M.D.

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
1	207P00000X	Emergency Medicine Physician	J6917	TX
2	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	J6917	TX
3	2083A0100X	Aerospace Medicine Physician	J6917	TX

General Provider Information

NPI Number	:	1467422402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH PAUL DERVAY M.D.

Provider Business Mailing Address
First Line	:	4510 MASTERS DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5805
Country	:	US
Telephone Number	:	281-334-0223
Fax Number	:	281-334-0223

Provider Business Practice Location Address
First Line	:	NASA JOHNSON SPACE CENTER FLIGHT MEDICINE CLINIC
Second Line	:	2101 NASA ROAD ONE
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-483-7999
Fax Number	:	281-483-3392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	08/24/2010

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