Individual
DERICK PETRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
928 SCHOOL ST, HOUMA, LA 70360-4628
(985) 851-1970
Mailing address
1418 LOUISE ST, THIBODAUX, LA 70301-4259
(985) 791-4344
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
200781
LA
Other
Enumeration date
01/23/2015
Last updated
01/23/2015
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