Provider Demographics
NPI:1366025934
Name:DERI, ALEXANDER CHARLES
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CHARLES
Last Name:DERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BETHESDA HEALTH EAST, GME SUITE - EMERGENCY MEDICINE
Mailing Address - Street 2:2815 SOUTH SEACREST BLVD.
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-479-6344
Mailing Address - Fax:
Practice Address - Street 1:BETHESDA HEALTH EAST, GME SUITE - EMERGENCY MEDICINE
Practice Address - Street 2:2815 SOUTH SEACREST BLVD.
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-479-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program