Individual
PETER DEREVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2000 GLEN ECHO RD STE 105, NASHVILLE, TN 37215-2857
(214) 687-2392
(214) 602-7003
Mailing address
2845 CASCADE COVE DR, LITTLE ELM, TX 75068-7607
(214) 687-2392
(214) 602-7003
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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