MEDICARE: DR. DAVID BRIAN DERR PH.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	103T00000X	Psychologist
2	103TC1900X	Counseling Psychologist	06-05P	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y483	OTHER	AR	BLUECROSS PROVIDER NUMBER

General Provider Information

NPI Number	:	1700832938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRIAN DERR PH.D.

Provider Business Mailing Address
First Line	:	8500 N STEMMONS FWY STE 5040
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3050
Country	:	US
Telephone Number	:	214-670-6486
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N STEMMONS FWY STE 5040
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3050
Country	:	US
Telephone Number	:	214-670-6486
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/14/2013

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