Individual
DR. PATRICK DERBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4700 N HABANA AVE STE 400, TAMPA, FL 33614-7119
(813) 499-0774
Mailing address
15815 SHADDOCK DR STE 130, WINTER GARDEN, FL 34787-5773
(813) 400-1140
(813) 701-9132
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO4422
FL
213EP1101X
Primary Podiatric Medicine Podiatrist
PO4422
FL
213ES0000X
Sports Medicine Podiatrist
PO4422
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO4422
FL
213ES0131X
Foot Surgery Podiatrist
PO4422
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114530400
—
FL
01
—
15659126
CAQH ID
—
01
—
6605657
AETNA
FL
01
—
7333506
CIGNA ID
FL
01
—
OPOAV
BCBS
FL
Enumeration date
04/04/2019
Last updated
03/10/2025
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