Individual
MR. JAMES QUINCEY DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
CR 0324 HWY 84 N #14, TIERRA AMARILLA, NM 87575
(575) 588-7252
(575) 588-9132
Mailing address
PO BOX 250, TIERRA AMARILLA, NM 87575-0250
(575) 588-7252
(575) 588-9132
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2009-0016
NM
Other
Enumeration date
07/31/2009
Last updated
08/22/2011
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