Provider Demographics
NPI:1275659302
Name:MUNDEY, DERICK ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DERICK
Middle Name:ALAN
Last Name:MUNDEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:WRAMC, BLDG 2, ROOM 2J38
Mailing Address - Street 2:6900 GEORGIA AVE, NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0001
Mailing Address - Country:US
Mailing Address - Phone:202-782-3321
Mailing Address - Fax:202-782-5007
Practice Address - Street 1:WRAMC, BLDG 2, ANESTHESIA DEPARTMENT
Practice Address - Street 2:6900 GEORGIA AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013871207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology