Derek Bazemore MD Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

DEREK BAZEMORE MD INC

Practice address

55 SW 9TH St Apt 1405
Miami, FL 33130-3992

Phone

(917) 750-5709

NPI assigned

May 10, 2023

Organization subpart

No

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

Authorized official

Name

Derek Glenn Bazemore Jr., MD

Title

President

Phone

(917) 750-5709

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1487344875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 SW 9TH ST APT 1405",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331303992",
            "telephone_number": "917-750-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 SW 9TH ST APT 1405",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331303992",
            "telephone_number": "917-750-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK BAZEMORE MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "BAZEMORE",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-750-5709",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Victoria Deras
• Aditya Manjul Derasari, M.D.
• Talar Derashodian, M.D.
• Marcel J Deray, MD
• Laura Derderian, CCC-SLP
• Joseph Dergan, MD
• Audrey Elaine Dericho
• Florence Derilus
• Voltaire Derine, PHARM D.
• Derm 360, LLC

• General Practice Physician in Miami, FL
• Providers in Miami, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; 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.