Provider Demographics
NPI:1003055815
Name:RINGERS, DEREK (PA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:RINGERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E STATE HIGHWAY 260 STE G
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4921
Mailing Address - Country:US
Mailing Address - Phone:928-596-4570
Mailing Address - Fax:
Practice Address - Street 1:101 E ST HWY 260 STE G
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4921
Practice Address - Country:US
Practice Address - Phone:928-596-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003928363AM0700X
AZ5084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical