Individual
DEREK DANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2700 E 29TH ST STE 260, BRYAN, TX 77802-2587
(979) 774-0012
(979) 774-4636
Mailing address
1426 COUNTY ROAD 436, DIME BOX, TX 77853-5248
(979) 716-7915
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15097
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578232310
—
TX
01
—
Q00486203
RAILROAD MEDICARE
TX
Enumeration date
09/07/2021
Last updated
09/09/2025
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