Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 4301029287 | MI |
NPI | 1023012473 |
---|---|
Provider Name | Frank Nelson Derr |
First Address | Rochester, MI 48308-0070 |
Second Address | Rochester Hills, MI 48307-4511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 08/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10-2634566 | (05) | MI |
45234 | BLUE CROSS BLUE SHIELD (01) | MI |
E37253 | (02) | MI |