Provider Demographics
NPI:1043409246
Name:THORPE, DEREK BERESFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:BERESFORD
Last Name:THORPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4022 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5417
Mailing Address - Country:US
Mailing Address - Phone:904-778-8799
Mailing Address - Fax:904-778-8468
Practice Address - Street 1:4022 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5417
Practice Address - Country:US
Practice Address - Phone:904-778-8799
Practice Address - Fax:904-778-8799
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN118582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology