Individual
DEREK COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 POTTERY AVE, PORT ORCHARD, WA 98366-3711
(360) 895-5000
Mailing address
1400 POTTERY AVE, PORT ORCHARD, WA 98366-3711
(360) 895-5000
(360) 895-5034
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00024310
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8111726
—
WA
Enumeration date
01/25/2007
Last updated
04/05/2021
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