Individual
DEREK Q DARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1340 W TUNNEL BLVD STE 230, HOUMA, LA 70360-2811
(985) 293-7322
(985) 231-1377
Mailing address
1340 W TUNNEL BLVD STE 230, HOUMA, LA 70360-2811
(985) 293-7322
(985) 231-1377
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336500743
—
LA
Enumeration date
10/24/2018
Last updated
07/22/2024
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