Derkaz, Jerold A

Derkaz, Jerold A is an sole proprietor health care provider with primary practice located at 1290 Circle Dr , Defuniak Springs FL 32435-2505. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Derkaz, Jerold A can be contacted via phone (850) 892-6600.

Contact Information

Primary practice address
1290 Circle Dr Defuniak Springs FL 32435-2505
Phone: (850) 892-6600
Fax: (850) 520-4660
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME0046412 Florida

Profile Details

NPI number 1588772883
LBN Legal business name Derkaz, Jerold A
Credentials M.D., P.A.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 27th, 2006
Last updated May 19th, 2011 - about 14 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 1588772883 NPPES
Florida Other 76015 BCBS PROVIDER #
Florida Other K3534 BCBS PROVIDER #
Florida MEDICAID 262982800 BCBS PROVIDER #

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