Dane, Derek

Dane, Derek is an sole proprietor health care provider with primary practice located at 2700 E 29Th St Ste 260 , Bryan TX 77802-2587. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Dane, Derek can be contacted via phone (979) 774-0012.

Contact Information

Primary practice address
2700 E 29Th St Ste 260 Bryan TX 77802-2587
Phone: (979) 774-0012
Fax: (979) 774-4636
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA15097 Texas

Profile Details

NPI number 1578232310
LBN Legal business name Dane, Derek
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 7th, 2021
Last updated Nov 22nd, 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 1578232310 NPPES
Texas MEDICAID 1578232310
Texas Other Q00486203

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