Individual
DERRICK S TOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
014663
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030440
ANTHEM
ME
01
—
1041053
AETNA
—
05
—
255890099
—
ME
Enumeration date
09/27/2006
Last updated
12/05/2012
Update your record
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