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1760463525

NPI Code Detail

MEDICARE: DR. JAMES A DERBY MD

MEDICARE: DR. JAMES A DERBY 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	207P00000X	Emergency Medicine Physician	ME80573	FL
2	207Q00000X	Family Medicine Physician	ME80573	FL
3	208M00000X	Hospitalist Physician	ME80573	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	059185372	OTHER	AL	BCBS AL
2	059185483	OTHER	AL	BCBS AL
3	51635	OTHER	FL	BC/BS FL
4	97861	OTHER	FL	BCBS FL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760463525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A DERBY MD

Provider Business Mailing Address
First Line	:	457 RUCKEL DR
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-1782
Country	:	US
Telephone Number	:	850-496-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 HIGHWAY 85 N
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-1045
Country	:	US
Telephone Number	:	850-678-4181
Fax Number	:	850-729-9418

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	05/09/2023

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Directions to “ DR. JAMES A DERBY MD” Practice Location

Language	Start Address	Practice Location

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