Individual
DR. DUSTIN CLIFTON DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 12TH AVE STE 100, FORT WORTH, TX 76104-2519
(817) 810-0770
(817) 820-0242
Mailing address
800 12TH AVE STE 100, FORT WORTH, TX 76104-2519
(817) 810-0770
(817) 820-0242
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
Q4085
TX
208600000X
Surgery Physician
Q4085
TX
390200000X
Student in an Organized Health Care Education/Training Program
57. 025880
OH
Other
Enumeration date
08/03/2010
Last updated
10/13/2021
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