Costa, Derek

Costa, Derek is an individual health care provider with primary practice located at 1400 Pottery Ave , Port Orchard WA 98366-3711. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Costa, Derek can be contacted via phone (360) 895-5000.

Contact Information

Primary practice address
1400 Pottery Ave Port Orchard WA 98366-3711
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00024310 Washington

Profile Details

NPI number 1215082359
LBN Legal business name Costa, Derek
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2007
Last updated Apr 5th, 2021 - about 5 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 1215082359 NPPES
Washington MEDICAID 8111726

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