Provider Demographics
NPI:1023012473
Name:DERR, FRANK NELSON (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:NELSON
Last Name:DERR
Suffix:
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:PO BOX 80070
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-0070
Mailing Address - Country:US
Mailing Address - Phone:248-852-3636
Mailing Address - Fax:248-852-3631
Practice Address - Street 1:375 BARCLAY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4511
Practice Address - Country:US
Practice Address - Phone:248-852-3636
Practice Address - Fax:248-852-3631
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029287207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45234OtherBLUE CROSS BLUE SHIELD
MI10-2634566Medicaid
MI10-2634566Medicaid
MI45234OtherBLUE CROSS BLUE SHIELD