Individual
JEFFREY DERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1919 W PARK DR, NORTH WILKESBORO, NC 28659-3564
(336) 651-2980
(336) 667-2047
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 651-2980
(336) 667-2047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25260
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7928360
—
NC
Enumeration date
01/18/2006
Last updated
02/04/2013
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