Individual
MARK WALTER DEROO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23450 COLLEGE BLVD, OLATHE, KS 66061-8702
(913) 764-7788
(913) 764-6088
Mailing address
23450 COLLEGE BLVD, OLATHE, KS 66061-8702
(913) 764-7788
(913) 764-6088
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0427012
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100293370E
—
KS
Enumeration date
05/17/2006
Last updated
08/19/2011
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