Individual
DR. MICAH JON DERBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6600 S YALE AVE STE 650, TULSA, OK 74136-3342
(918) 502-7800
(918) 502-7815
Mailing address
6600 S YALE AVE STE 1200, TULSA, OK 74136-3333
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5550
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200541190A
—
OK
05
—
200541190B
—
OK
01
—
442012YMSD
MEDICARE
OK
Enumeration date
05/08/2013
Last updated
10/15/2024
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