Derick Mayberry
Periodontist
113 Lielmanis Ave
Hurlburt Field
, Florida 32544-5613
Derick Mayberry
Periodontist
113 Lielmanis Ave
Hurlburt Field
, Florida 32544-5613
(575) 956-5112
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About
Features
Specialties
- Periodontist
Languages spoken
- English
Location
First Address
- Derick Mayberry
- 4320 Commons Dr W Unit 5305
- Destin, FL
- Zip : 32541-8660
- Phone : (575) 956-5112
Second Address
- Derick Mayberry
- 113 Lielmanis Ave
- Hurlburt Field, FL
- Zip : 32544-5613
- Phone : (850) 881-2000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0300X | Periodontist | 016.0123575 | VT |
National Provider Identifier
| NPI | 1003369422 |
|---|---|
| Provider Name | Derick Mayberry |
| First Address | Destin, FL 32541-8660 |
| Second Address | Hurlburt Field, FL 32544-5613 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/08/2016 |
| Last Update Date | 01/09/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.