Individual
JUSTIN DANIEL DERGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6000
Mailing address
1000 E PRIMROSE ST STE 520, SPRINGFIELD, MO 65807-5180
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2022026075
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2018
Last updated
10/05/2022
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