Provider Demographics
NPI:1093150773
Name:BATSON, DEREK (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BATSON
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 1:300 PINELLAS ST # MS 47
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3804
Mailing Address - Country:US
Mailing Address - Phone:727-462-7907
Mailing Address - Fax:727-462-7904
Practice Address - Street 1:300 PINELLAS ST # MS 47
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3804
Practice Address - Country:US
Practice Address - Phone:727-462-7907
Practice Address - Fax:727-462-7904
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017012768207R00000X
WV26423207R00000X
NMMD2017-0750207R00000X
390200000X
FLME153738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program