Individual
DR. DEREK THOMAS DIRKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 N SYRINGA ST STE 205, POST FALLS, ID 83854-5275
(208) 262-0945
(208) 415-0150
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854-5326
(208) 262-0945
(208) 415-0150
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-15190
ID
208600000X
Surgery Physician
MD193751
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427476225
—
ID
05
—
2136241
—
WA
Enumeration date
03/31/2014
Last updated
04/22/2024
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