Derek R Fleitz, D D S P A

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 15148 Issued in FL

Practice address

2407 W 11TH St
Panama City, FL 32401-1634

Phone

(850) 763-5770

NPI assigned

Jul 12, 2006

Last updated

Jun 12, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434067200000",
    "number": "1174558647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 611373",
            "city": "ROSEMARY BEACH",
            "state": "FL",
            "postal_code": "324611003",
            "telephone_number": "850-231-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 W 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324011634",
            "telephone_number": "850-763-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEITZ",
        "first_name": "DEREK",
        "middle_name": "R",
        "credential": "D D S P A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2015-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 15148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Panama City, FL
• Providers in Panama City, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; 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.