Individual
DEREK JUSTICE JAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
03920 SOUTHLAND RD, NEW BREMEN, OH 45869-9790
(419) 629-2772
(419) 629-3613
Mailing address
830 W MAIN ST, COLDWATER, OH 45828-1626
(567) 890-7143
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0036746
OH
Other
Enumeration date
01/23/2024
Last updated
07/22/2024
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