Provider Demographics
NPI:1366494742
Name:HILTZ, DEREK JOHN (DO)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JOHN
Last Name:HILTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PASADENA AVE S STE 501
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2126
Mailing Address - Country:US
Mailing Address - Phone:727-343-6119
Mailing Address - Fax:727-345-6286
Practice Address - Street 1:508 PASADENA AVE S STE 501
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2126
Practice Address - Country:US
Practice Address - Phone:727-343-6119
Practice Address - Fax:727-345-6286
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S9333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278578100Medicaid
FL16671YMedicare PIN
FLI41332Medicare UPIN