Individual
GARY A DERAAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 323-5956
(859) 323-1080
Mailing address
26699 MOHAWK DR, PERRYSBURG, OH 43551-5403
(419) 690-7652
(419) 697-7726
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3004238
KY
367500000X
Certified Registered Nurse Anesthetist
RN 279724
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000556304
ANTHEM
—
01
—
04097A
PARAMOUNT
OH
01
—
341881145-003
MMO
OH
05
—
5182096
—
MI
05
—
74007279
—
KY
01
—
P00619434
RRMC
—
Enumeration date
08/11/2005
Last updated
09/22/2025
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