Deric Rachjaibun, MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41861 Issued in CO

Legal business name

DERIC RACHJAIBUN, MD LLC

Practice address

1750 Race St
Denver, CO 80206-1114

Phone

(303) 355-7414

NPI assigned

Sep 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Derik Rachjaibun, M.D.

Title

Owner

Phone

(303) 355-7414

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deric J Rachjaibun, MD

  • Family Medicine Physician
  • Northglenn, CO
  • NPI 1902903933
  NPD (past)

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1497949325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 RACE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802061114",
            "telephone_number": "303-355-7414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 RACE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802061114",
            "telephone_number": "303-355-7414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERIC RACHJAIBUN, MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "RACHJAIBUN",
        "authorized_official_first_name": "DERIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-355-7414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "41861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16020332",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dept. of Corrections-DWCF
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• Cathleen M Derickson, LPC
• Kevin Matthew Derickson, D.P.M.
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• Mariah Dermody, PMHNP-BC

• Family Medicine Physician in Denver, CO
• Providers in Denver, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.