Individual
DR. DERECK A. PEERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
915 10TH AVE NW, ARDMORE, OK 73401-4025
(580) 223-7200
(580) 223-7207
Mailing address
915 10TH AVE NW, ARDMORE, OK 73401-4025
(580) 223-7200
(580) 223-7207
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
4546
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200124470A
—
OK
01
—
OK700279
INDIVIDUAL PTAN
OK
01
—
P00442554
RAILROAD MEDICARE
—
Enumeration date
04/03/2007
Last updated
07/23/2009
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