Individual
DR. DEREK GLENN BAZEMORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12750 SW 128TH ST STE 108, MIAMI, FL 33186-5380
(917) 750-5709
Mailing address
55 SW 9TH ST APT 1405, MIAMI, FL 33130-3992
(917) 750-5709
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME107380
FL
207Q00000X
Family Medicine Physician
Primary
ME107380
FL
208D00000X
General Practice Physician
ME107380
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002509700
—
FL
Enumeration date
04/08/2010
Last updated
06/14/2023
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