Dirk Jon Derksen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AD6655394 Issued in WI

Practice address

10 Wagon Wheel Dr
Appleton, WI 54913-9782

Phone

(920) 731-6374

NPI assigned

Sep 15, 2005

Last updated

Feb 17, 2009By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234828800000",
    "number": "1013902055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WAGON WHEEL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139782",
            "telephone_number": "920-731-6374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WAGON WHEEL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139782",
            "telephone_number": "920-731-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "DIRK",
        "middle_name": "JON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "AD6655394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31145100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Haven for Children SC
• Jayden Der, M.D.
• Erin Lynn Dercks, APNP
• Dana M Derenne, RD
• Nicholas Derkowski
• Todd Alan Derksen, DPM
• Stephen R Dernlan, MD
• Nicole Kristina Derse, CNC
• Joy Lucille Des Jardins, COTA
• Katie Jean Des Jardins

• Family Medicine Physician in Appleton, WI
• Providers in Appleton, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; 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.