Eddie, Derek
Eddie, Derek is an individual health care provider with primary practice located at 560 Memorial Dr , Pocatello ID 83201-4073. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Eddie, Derek can be contacted via phone (208) 234-1960.Contact Information
Primary practice address
560 Memorial Dr
Pocatello ID 83201-4073
Phone: (208) 234-1960
Fax: (208) 233-5033
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA-662 | Idaho |
Profile Details
| NPI number | 1346375367 |
|---|---|
| LBN Legal business name | Eddie, Derek |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 22nd, 2007 |
| Last updated | Jul 8th, 2007 - about 18 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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