Individual
GERALD DERISE
Active
Individual
GERALD DERISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
573282
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306429800
—
FL
01
—
G0579
BLUE CROSS BLUE SHIELD FL
FL
01
—
P00274577
RAILROAD MEDICARE
FL
Enumeration date
05/31/2006
Last updated
05/24/2010
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