Dr. Kevin Mathew Derickson, DPM
Primary Podiatric Medicine Podiatrist in Tallahassee, Florida
NPI 1396748497

Kevin Mathew Derickson is a Primary Podiatric Medicine Podiatrist based in Tallahassee, FL and is specialized in Primary Podiatric Medicine. Kevin Mathew Derickson practices in Tallahassee, FL and has the professional credentials of DPM. The NPI Number for Kevin Mathew Derickson is 1396748497 and holds a License No. PO2824 (Florida).

The current practice location address for Kevin Mathew Derickson is 2770 Capital Medical Blvd Ste 200, Tallahassee, FL and can be reached out via phone at 850-878-8235 and via fax at850-219-2352. You can also correspond with Kevin Mathew Derickson through the mailing address at 2770 CAPITAL MEDICAL BLVD STE 200, TALLAHASSEE, FL - 32308-8419 (mailing address contact number: 850-878-8235).

person
Provider Profile Details
NPI Number
1396748497
Provider Name
Kevin Mathew Derickson
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
2770 Capital Medical Blvd Ste 200, Tallahassee, FL, 32308-8419
Phone Number
850-878-8235
Fax Number
850-219-2352
Provider Enumeration Date
05/23/2005
Last Update Date
08/20/2016
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Provider's Legacy Identifiers
Identifier Type State Issuer
99039 01 FL GROUP BCBS ID
65635 01 FL BCBS PROVIDER NUMBER
000901249C 05 GA
P00625824 01 FL MEDICARE RAIL ROAD
340058100 05 FL
institution
Provider Business Practice Location Address Details
Address
2770 Capital Medical Blvd Ste 200
City
Tallahassee
State
Florida
Zip
32308-8419
Phone Number
850-878-8235
Fax Number
850-219-2352
person
Provider Business Mailing Address Details
Address
2770 Capital Medical Blvd Ste 200
City
Tallahassee
State
Florida
Zip
32308-8419
Phone Number
850-878-8235
Fax Number
850-219-2352
person
Provider's Primary Taxonomy Details
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Primary Podiatric Medicine
Taxonomy
213EP1101X
License No.
PO2824 (Florida)
Definition
Definition to come...