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Organization
JEROLD A. DERKAZ, MD PA
Active
Organization
JEROLD A. DERKAZ, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ARCABASCIO (RECEPTIONIST)
(850) 892-6600
Entity
Organization
Contact information
Practice address
1290 CIRCLE DR, DEFUNIAK SPRINGS, FL 32435-2505
(850) 892-6600
(850) 520-4660
Mailing address
1290 CIRCLE DR, DEFUNIAK SPRINGS, FL 32435-2505
(850) 892-6600
(850) 520-4660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0046412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262982800
—
FL
01
—
76015
BCBS
FL
01
—
K3534
MEDICARE ID
FL
Enumeration date
12/17/2007
Last updated
05/19/2011
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