Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2006015616 | MO |
N | 208600000X | Surgeon | 2006015616 | MO |
Y | 2086S0120X | Pediatric Surgery | 283192 | NY |
NPI | 1649483181 |
---|---|
Provider Name | Mr. Derek Steven Wakeman |
First Address | Rochester, NY 14642-0001 |
Second Address | Rochester, NY 14642-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 06/09/2016 |