Dirk Jon Derksen MD

NPI 1013902055 - Family Medicine - 207Q00000X

NPI Details
NPI 1013902055
Gender Male
Enumeration Date 09/15/2005
Last Updated 02/17/2009
Entity Type Individual
Active Over 11 years ago
Practice Location
10 WAGON WHEEL DR
APPLETON WI, 54913-9782, US
Phone (920) 731-6374
Fax
Business Location
10 WAGON WHEEL DR
APPLETON WI, 54913-9782, US
Phone (920) 731-6374
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State Wisconsin
License Number AD6655394
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According to our database, Dirk Jon Derksen MD NPI is 1013902055, taxonomy code is 207Q00000X and license number is AD6655394, license state is located at Wisconsin. Dirk Jon Derksen MD physically located at 10 Wagon Wheel Dr, Appleton WI, 54913-9782. NPI Number Dirk Jon Derksen MD has the Individual type.

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1013902055 NPI number is provided on an as is basis without warranty of any kind. 1013902055 is maintained by the National Plan & Provider Enumeration System. The contents of Dirk Jon Derksen MD are for informational purposes only.