Wilfred Derksen, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C33691 Issued in CA

Practice address

1570 E Herndon Ave
Fresno, CA 93720-3303

Phone

(559) 437-7300

Fax

(559) 437-7153

NPI assigned

Sep 14, 2005

Last updated

Apr 30, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Medical Providers Medical Group Inc

  • Family Medicine Physician
  • Fresno, CA
  • NPI 1821075748
  NPD (past)
• Marvin P Matlock M D Inc

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1346486396
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1003801267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28900",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937298900",
            "telephone_number": "559-228-4205",
            "fax_number": "559-224-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203303",
            "telephone_number": "559-437-7300",
            "fax_number": "559-437-7153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "WILFRED",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C33691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Alfredo Deras Espinoza, MD
• Ani Hagop Derboghossian, PHARMD
• Haig Derboghossian
• Jason Derhovanesian, DO
• Adam Hicham Derkouch, PHARMD
• Pamela L Deroian, PHD
• Mark Derr
• Derric Brown LCSW, Licensed Clinical Social Worker Inc. (Streams of Hope Behavioral Health Care)
• Alessandra Gose Desabelle, DDS
• Jason Michael Desadier, D.O.

• Pediatrics Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.