Provider Demographics
NPI:1346237351
Name:TOWERY, DEREK S (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:S
Last Name:TOWERY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2829 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2525
Mailing Address - Country:US
Mailing Address - Phone:417-624-0440
Mailing Address - Fax:417-624-9652
Practice Address - Street 1:2829 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2525
Practice Address - Country:US
Practice Address - Phone:417-624-0440
Practice Address - Fax:417-624-9652
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO100734207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G46799Medicare UPIN
MO002013884Medicare PIN
MO208705905Medicaid
P00006545OtherRAILROAD MEDICARE