| James L Derickson Md Pc | |
|
1715 N Weber St Suite 270 Colorado Springs CO 80907-7532 | |
| (719) 473-8595 | |
| Not Available |
| Full Name | James L Derickson Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1715 N Weber St, Colorado Springs, Colorado |
| Authorized Official Name and Position | James L Derickson (CEO) |
| Authorized Official Contact | 7194738595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| James L Derickson Md Pc 3464 S Willow St Suite 540 Denver CO 80231-4531 Ph: (800) 929-5395 | James L Derickson Md Pc 1715 N Weber St Suite 270 Colorado Springs CO 80907-7532 Ph: (719) 473-8595 |
| NPI Number | 1427076223 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 10/31/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427076223 | NPI | - | NPPES |
| 86573730 | Medicaid | CO | |
| DEDE4191 | Other | CO | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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