Bazemore, Derek Glenn

Bazemore, Derek Glenn is an sole proprietor health care provider with primary practice located at 12750 Sw 128Th St Ste 108 , Miami FL 33186-5380. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Bazemore, Derek Glenn can be contacted via phone (917) 750-5709.

Contact Information

Primary practice address
12750 Sw 128Th St Ste 108 Miami FL 33186-5380
Phone: (917) 750-5709
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME107380 Florida
Allopathic & Osteopathic Physicians / General Practice 208D00000X ME107380 Florida
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME107380 Florida

Profile Details

NPI number 1639495245
LBN Legal business name Bazemore, Derek Glenn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 8th, 2010
Last updated Jun 14th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639495245 NPPES
Florida MEDICAID 002509700

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