Individual
DR. FRED J DERY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 STEINDLER WAY STE B, NORTH LIBERTY, IA 52317-7907
(319) 338-3606
(319) 338-0522
Mailing address
2301 STEINDLER WAY STE B, NORTH LIBERTY, IA 52317-7907
(319) 338-3606
(319) 338-0522
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
38968
IA
208VP0014X
Interventional Pain Medicine Physician
Primary
38968
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457569188
—
IA
01
—
I75560005
MEDICARE PTAN
IA
Enumeration date
05/18/2007
Last updated
03/28/2025
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