Individual
DR. ADAM KIRK DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-7799
Mailing address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.123597
IL
207R00000X
Internal Medicine Physician
TRAINING LICENSE
OH
Other
Enumeration date
10/02/2006
Last updated
11/08/2012
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