Individual
MR. DERICK LEE TIBBETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
638 S WHITTIER ST, WICHITA, KS 67207-2222
(316) 841-3810
Mailing address
638 S WHITTIER ST, WICHITA, KS 67207-2222
(316) 841-3810
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
02/17/2011
Last updated
02/17/2011
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