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Individual

DERRICK SCHUTRUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4893 TRANSIT RD, DEPEW, NY 14043-4698
(716) 608-7040
Mailing address
1961 BUSH RD, GRAND ISLAND, NY 14072-2915
(716) 936-4334

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
024885
NY
363A00000X
Physician Assistant
NY

Other

Enumeration date
06/09/2020
Last updated
06/09/2020
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