# DERBY DERM

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1871771998
- **Authorized official:** MR. TIM WEIDE P.A. (PRESIDENT)
- **Authorized official phone:** (316) 788-3376

## Contact information

- **Practice address:** 1121 N COLLEGE PARK ST, SUITE \# 400, DERBY, KS 67037-3665
- **Practice address phone:** (316) 788-3376
- **Practice address fax:** (316) 788-3378
- **Mailing address:** 1121 N COLLEGE PARK ST, SUITE \# 400, DERBY, KS 67037-3665
- **Mailing address phone:** (316) 788-3376
- **Mailing address fax:** (316) 788-3378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 1500761 | KS | Yes |

## Other

- **Enumeration date:** 01/31/2008
- **Last updated:** 01/31/2008