MEDICARE: DEREK D MUEHRCKE 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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME70163	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	780000716	OTHER		MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1568464774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK D MUEHRCKE MD

Provider Business Mailing Address
First Line	:	1824 KING ST
Second Line	:	STE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4736
Country	:	US
Telephone Number	:	904-384-3343
Fax Number	:	904-400-6671

Provider Business Practice Location Address
First Line	:	300 HEALTH PARK BLVD STE 5008
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-3705
Country	:	US
Telephone Number	:	904-494-2394
Fax Number	:	904-400-6676

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/22/2022

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