Paul Deridder, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

G33885 Issued in CA

Practice address

4108 River Ave
Newport Beach, CA 92663-2915

Phone

(714) 345-5887

Fax

(949) 548-1994

NPI assigned

Oct 5, 2011

Last updated

Oct 5, 2011By the provider in NPPES

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 names 1

• Dr. Paul Deridder Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1871877134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4108 RIVER AVE",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926632915",
            "telephone_number": "714-345-5887",
            "fax_number": "949-548-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4108 RIVER AVE",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926632915",
            "telephone_number": "714-345-5887",
            "fax_number": "949-548-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERIDDER",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-05",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "G33885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "DERIDDER",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Steven Charles Dennis, M.D.
• Dental Practices of Charles Zahedi
• Dawn Depke, B.A., OBT, NCBTMB
• Glen Depke, BS, ND
• Paul T Depompo, PSY.D.
• Dermatology & Laser Clinic, Inc.
• Dermclub X Madison Shreeve Inc
• Michael Derose, COTA/L
• Shaunak Subhash Desai, M.D.
• Tanya Sarkisian Desloover

• Urology Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.