Individual
JEREMY DERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3720 E PUEBLO AVE, MESA, AZ 85206-1821
(928) 200-3526
Mailing address
2310 E BROWN RD, MESA, AZ 85213-5226
(480) 649-9000
(480) 248-9206
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
AZ
Other
Enumeration date
08/31/2016
Last updated
10/21/2016
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