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Individual

LARRY A DERKSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
8200 W CENTRAL AVE, SUITE 1, WICHITA, KS 67212-9503
(316) 722-6260
(316) 721-8307
Mailing address
8200 W CENTRAL AVE, SUITE 1, WICHITA, KS 67212-9503
(316) 722-6260
(316) 721-8307

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
523839
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
052013
BLUE CROSS BLUE SHIELD
KS
01
080110403
TRAVELERS MEDICARE
KS
01
2863
PREFERRED HEALTH SYSTEMS
KS
01
4332116
AETNA
KS
Enumeration date
08/11/2006
Last updated
02/14/2011
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