Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | J8514 | TX |
NPI | 1003927930 |
---|---|
Provider Name | Christopher Joseph Derbes |
First Address | Bryan, TX 77802-2547 |
Second Address | Bryan, TX 77802-2547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042357601 | (05) | TX |
H13923 | (02) |