Individual
DAVID L DEREGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GUTHRIE SQ, ATTENTION: PROVIDER SERVICES VICKY DETRICK, SAYRE, PA 18840-1625
(570) 887-6323
(570) 887-6324
Mailing address
1 GUTHRIE SQ, ATTENTION: PROVIDER SERVICES VICKY DETRICK, SAYRE, PA 18840-1625
(570) 887-6323
(570) 887-6324
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35991
KY
2083X0100X
Occupational Medicine Physician
Primary
35991
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000236623
BCBS PROVIDER NUMBER
—
01
—
35991
LICENSE
KY
05
—
64018898
—
KY
Enumeration date
09/16/2006
Last updated
12/13/2011
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