Individual
ANTHONY CHRISTOPHER DERRICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5700
(208) 625-5708
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5700
(208) 625-5708
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
81336-021
WI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
O-1453
ID
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
TL-4136
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100254122
—
WI
Enumeration date
05/20/2016
Last updated
04/24/2024
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