Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 41240 | CO |
Y | 2080P0204X | Pediatric Emergency Doctor | 207008 | NY |
NPI | 1306829825 |
---|---|
Provider Name | Robert M Derr |
First Address | Amherst, NY 14226-3822 |
Second Address | Buffalo, NY 14222-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 29/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010308401 | UNIVERA (01) | |
000524879001 | BC/BS (01) | |
01760392 | (05) | NY |
071031000079 | FIDELIS (01) | |
3909473 | IHA (01) | |
77220561 | (05) | CO |
G57746 | (02) | |
G57746 | (02) | CO |