Provider Demographics
NPI:1033382411
Name:CODY, DEREK (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:CODY
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 1:3925 EMBASSY PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333
Mailing Address - Country:US
Mailing Address - Phone:330-668-4065
Mailing Address - Fax:330-668-4082
Practice Address - Street 1:3925 EMBASSY PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-668-4065
Practice Address - Fax:330-668-4082
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1285442086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery