Jeffrey Derick, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25260 Issued in NC

Practice address

1919 W Park Dr
North Wilkesboro, NC 28659-3564

Phone

(336) 651-2980

Fax

(336) 667-2047

NPI assigned

Jan 18, 2006

Last updated

Feb 4, 2013By 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)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1316927395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-651-2980",
            "fax_number": "336-667-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 W PARK DR",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593564",
            "telephone_number": "336-651-2980",
            "fax_number": "336-667-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERICK",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "25260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7928360",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; 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.