# JEROLD A. DERKAZ, MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477736106
- **Authorized official:** AMANDA ARCABASCIO (RECEPTIONIST)
- **Authorized official phone:** (850) 892-6600

## Contact information

- **Practice address:** 1290 CIRCLE DR, DEFUNIAK SPRINGS, FL 32435-2505
- **Practice address phone:** (850) 892-6600
- **Practice address fax:** (850) 520-4660
- **Mailing address:** 1290 CIRCLE DR, DEFUNIAK SPRINGS, FL 32435-2505
- **Mailing address phone:** (850) 892-6600
- **Mailing address fax:** (850) 520-4660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME0046412 | FL | Yes |

## Other

- **Enumeration date:** 12/17/2007
- **Last updated:** 05/19/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 262982800 | — | FL |
| 01 | — | 76015 | BCBS | FL |
| 01 | — | K3534 | MEDICARE ID | FL |