Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD064308L | PA |
Y | 207U00000X | Nuclear Medicine Specialist | MD064308L | PA |
NPI | 1700811924 |
---|---|
Provider Name | Derek Joseph Stocker |
First Address | Bethesda, MD 20816 |
Second Address | Bethesda, MD 20889-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 20/03/2012 |