Provider Demographics
NPI:1326145970
Name:COLMENAR, DERRICK (MD, FASA, FACHE)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:COLMENAR
Suffix:
Gender:M
Credentials:MD, FASA, FACHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 475 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 INAOKACHO
Practice Address - Street 2:
Practice Address - City:YOKOSUKA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:2380001
Practice Address - Country:JP
Practice Address - Phone:011-814-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96706207L00000X
VA0101255889207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology