Dera, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DERA, INC

Doing business as

Foot Solutions-Ft Wayne

Practice address

513 E Coliseum Blvd
Fort Wayne, IN 46805-1215

Phone

(260) 484-8966

Fax

(260) 484-0508

NPI assigned

Jun 29, 2006

Organization subpart

No

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

Authorized official

Name

Douglas Rex Bruick, C.PED.

Title

Owner

Phone

(260) 484-8966

Specialties & licenses 1

Addresses

Other names 1

• FOOT SOLUTIONS-FT WAYNE Doing business as

Locations

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1710915731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 E COLISEUM BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051215",
            "telephone_number": "260-484-8966",
            "fax_number": "260-484-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 E COLISEUM BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051215",
            "telephone_number": "260-484-8966",
            "fax_number": "260-484-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "BRUICK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "REX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-484-8966",
        "authorized_official_credential": "C.PED."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOOT SOLUTIONS-FT WAYNE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Jordan Denyse, M.A.
• Department of Veteran Affairs
• Elizabeth Rene Depew, MSN, FNP-BC
• Carry E Depold, PA C
• Ida Marie Depree, MAMFT
• Karen Derickson
• Keith J. Derickson, MD
• Dermatology and Laser Surgery Associates of Fort Wayne P.C.
• Dennis M Derosa, MD
• Diana Derrer, OTD, OTR/L

• Durable Medical Equipment & Medical Supplies in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.