Beaumont Kidney Specialists, PA

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

BEAUMONT KIDNEY SPECIALISTS, PA

Practice address

2965 Harrison Street, Suite 317
Beaumont, TX 77702-1150

Phone

(409) 554-0911

Fax

(409) 554-0912

NPI assigned

Nov 8, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Raymond Derderian, M.D.

Title

Owner

Phone

(409) 554-0911

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1352332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352332800000",
    "number": "1730433038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 HARRISON STREET, SUITE 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 STREET, SUITE 317",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021150",
            "telephone_number": "409-554-0911",
            "fax_number": "409-554-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUMONT KIDNEY SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-08",
        "last_updated": "2012-11-08",
        "status": "A",
        "authorized_official_last_name": "DERDERIAN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-554-0911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Beaumont Lotus Dental
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• Beaumont Nephrology Associates
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• 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 Nov 8, 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.