Individual
DERRICK L. HASENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 N MILFORD DR, FRANKLIN, IN 46131-7308
(317) 739-4848
(317) 346-4062
Mailing address
14 TRAFALGAR SQ, TRAFALGAR, IN 46181-9515
(317) 412-9190
(317) 878-2302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01071061A
IN
207Q00000X
Family Medicine Physician
11015132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201067650
—
IN
Enumeration date
06/30/2008
Last updated
10/14/2019
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