Deregis, David L
Deregis, David L is an individual health care provider with primary practice located at 1 Guthrie Sq Attention: Provider Services Vicky Detrick, Sayre PA 18840-1625. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Occupational Medicine. Allopathic & Osteopathic Physicians / Occupational Medicine is his primary health care specialty. Deregis, David L can be contacted via phone (570) 887-6323.Contact Information
Primary practice address
1 Guthrie Sq Attention: Provider Services Vicky Detrick
Sayre PA 18840-1625
Phone: (570) 887-6323
Fax: (570) 887-6324
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 35991 | Kentucky |
| Allopathic & Osteopathic Physicians / Occupational Medicine | 2083X0100X | 35991 | Kentucky |
Profile Details
| NPI number | 1770689895 |
|---|---|
| LBN Legal business name | Deregis, David L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 16th, 2006 |
| Last updated | Dec 13th, 2011 - about 13 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 | 1770689895 | NPPES |
| Other | 000000236623 | BCBS PROVIDER NUMBER | |
| Other | 35991 | BCBS PROVIDER NUMBER | |
| MEDICAID | 64018898 | BCBS PROVIDER NUMBER |
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