Individual
DEREK MOELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
208 COUNTRY CLUB RD, HOUSTON, MS 38851-9326
(662) 456-3437
(662) 452-2070
Mailing address
1114 COMMONWEALTH BLVD, TUPELO, MS 38804-9301
(662) 456-3437
(662) 452-2070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MS17537
MS
207R00000X
Internal Medicine Physician
Primary
17537
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125350
—
MS
05
—
09013750
—
MS
Enumeration date
09/26/2006
Last updated
10/11/2016
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