Individual
DR. DEREK K. (KENT) LICHOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
H4491
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1278087-03
CSHCN
TX
05
—
1278087-04
—
TX
01
—
200039616
RR/MEDICARE
TX
01
—
86J300
BLUE SHIELD
TX
Enumeration date
03/27/2006
Last updated
11/08/2013
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