Davis, Dereck

Davis, Dereck is an individual health care provider with primary practice located at 2600 N State St , Jackson MS 39216-4301. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Davis, Dereck can be contacted via phone (601) 984-5220.

Contact Information

Primary practice address
2600 N State St Jackson MS 39216-4301
Phone: (601) 984-5220
Fax: (601) 984-5279
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2007-00180 North Carolina
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 18418 Mississippi

Profile Details

NPI number 1174567580
LBN Legal business name Davis, Dereck
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Aug 11th, 2014 - about 10 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 1174567580 NPPES
Mississippi MEDICAID 02170804

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