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Individual

DALE E DERICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5300 HARROUN RD, SUITE 304, SYLVANIA, OH 43560-2182
(419) 824-1100
(419) 824-1771
Mailing address
5300 HARROUN RD, SUITE 304, SYLVANIA, OH 43560-2182
(419) 824-1100
(419) 824-1771

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35044704
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000142525
ANTHEM
OH
01
000000385212
ANTHEM COMMERICAL
OH
01
0000004002383
ANTHEM MEDICAID
OH
05
0458802
OH
01
142491
PRIORITY HEALTH
MI
01
142491
CARE CHOICES
OH
01
2974411950-006
MEDICAL MUTUAL
OH
01
344428256
BEECH STREET
CA
01
344428256
EMERALD
OH
01
4002382
AETNA
OH
05
4826635
MI
01
8081472
CIGNA
OH
01
PH00240649
NATIONWIDE
OH
Enumeration date
06/24/2005
Last updated
03/18/2014
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