Derby Derm

NPI #1871771998 in Derby, Kansas

Provider Information

NPI Number: 1871771998
Entity Type: Organization
Organization Name: Derby Derm
Primary Specialty: Physician Assistant
Enumeration Date: Jan 31, 2008
Last Updated: Jan 31, 2008

Practice Location

Address: 1121 N COLLEGE PARK ST
Address 2: SUITE # 400
City: Derby
State: Kansas
ZIP Code: 67037-3665
Phone: (316) 788-3376

Authorized Official

Name: MR. TIM WEIDE, P.A.
Title: PRESIDENT
Phone: (316) 788-3376

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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