Individual
DR. DERYCK S WATERMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 627-4930
(253) 627-4649
Mailing address
10420 KOPACHUCK DR NW, GIG HARBOR, WA 98335-5970
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00027177
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58268
L&I
—
05
—
8127623
—
WA
01
—
WA8431
D/S REGENCE 90
—
Enumeration date
06/29/2006
Last updated
07/08/2007
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