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
Phone: (360) 895-5000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215082359 | NPPES |
| Washington | MEDICAID | 8111726 |
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