Provider Demographics
NPI:1013008481
Name:DERBY, RICHARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:DERBY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-755-0733
Mailing Address - Fax:650-755-3018
Practice Address - Street 1:901 CAMPUS DRIVE
Practice Address - Street 2:SUITE 312
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-755-0733
Practice Address - Fax:650-755-3018
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24348207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G24348OtherCALIF BOARD
G24348OtherCALIF BOARD
00G243480Medicare ID - Type Unspecified