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Individual
LARRY A DERKSEN
Active
Individual
LARRY A DERKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
523839
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052013
BLUE CROSS BLUE SHIELD
KS
01
—
080110403
TRAVELERS MEDICARE
KS
01
—
2863
PREFERRED HEALTH SYSTEMS
KS
01
—
4332116
AETNA
KS
Enumeration date
08/11/2006
Last updated
02/14/2011
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