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1588660849

NPI Code Detail

MEDICARE: DR. SCOTT A DERKUM MD

MEDICARE: DR. SCOTT A DERKUM 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	207R00000X	Internal Medicine Physician	C54344	CA
2	207R00000X	Internal Medicine Physician	ME74898	FL
3	208M00000X	Hospitalist Physician	C54344	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00939089	OTHER	CA	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1588660849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT A DERKUM MD

Provider Business Mailing Address
First Line	:	PO BOX 3589
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-8589
Country	:	US
Telephone Number	:	657-241-3600
Fax Number	:	657-241-7708

Provider Business Practice Location Address
First Line	:	16200 SAND CANYON AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-3714
Country	:	US
Telephone Number	:	949-610-7245
Fax Number	:	657-241-7720

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	05/30/2017

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Directions to “ DR. SCOTT A DERKUM MD” Practice Location

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