Raymond Derderian, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

H0043 Issued in TX

Practice address

2965 Harrison St
Ste 317
Beaumont, TX 77702-1150

Phone

(409) 554-0911

Fax

(409) 554-0912

NPI assigned

Jun 13, 2005

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

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

Interoperability endpoints

• Direct secure messaging: raymond.derderian@beaumontkidney.directbygreenway.com

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1699779090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 HARRISON ST",
            "address_2": "STE 317",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021150",
            "telephone_number": "409-554-0911",
            "fax_number": "409-554-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 HARRISON ST",
            "address_2": "STE 317",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021150",
            "telephone_number": "409-554-0911",
            "fax_number": "409-554-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDERIAN",
        "first_name": "RAYMOND",
        "name_prefix": "Prof.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "H0043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113566701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Dennison
• David Martin Dent, D.D.S
• Dental & Specialty Imaging
• Dept of Assistive & Rehab Serv - Beaumont Field Office
• Alyssa Nicole Deramus, M.S. SLP-INTERN
• Dermatology and Laser Medicine of Southeast Texas PLLC
• Tripp A Derouen, CRNA
• Pari Rajesh Desai
• Rajen B Desai, MD
• Aimee Desilet Weissmann

• Nephrology Physician in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; 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.