Individual
DERICK RENE DU VIVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW JACKSON PARK RD., PORTLAND, OR 97239-3011
(503) 494-7641
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE SJH-2, PORTLAND, OR 97239-3011
(503) 494-7641
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
24146
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286645
—
OR
Enumeration date
06/29/2006
Last updated
09/13/2016
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