Provider Demographics
NPI:1275527905
Name:DERBYSHIRE, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:DERBYSHIRE
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 1:1051 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1710
Mailing Address - Country:US
Mailing Address - Phone:252-937-4084
Mailing Address - Fax:252-937-7538
Practice Address - Street 1:1051 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1710
Practice Address - Country:US
Practice Address - Phone:252-937-4084
Practice Address - Fax:252-937-7538
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC196944OtherCIGNA HEALTHCARE
NC28356OtherBCBSNC
NC22965OtherMEDCOST
NC8928356Medicaid
NC22965OtherMEDCOST
NC28356OtherBCBSNC