MEDICARE: DR. DEREK JUE 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	207Q00000X	Family Medicine Physician	A52948	CA

General Provider Information

NPI Number	:	1679592976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK JUE M.D.

Provider Business Mailing Address
First Line	:	1812 SAN MIGUEL DR
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-8606
Country	:	US
Telephone Number	:	925-944-9193
Fax Number	:	925-944-0682

Provider Business Practice Location Address
First Line	:	1812 SAN MIGUEL DR
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-8606
Country	:	US
Telephone Number	:	925-944-9193
Fax Number	:	925-944-0682

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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