Provider Demographics
NPI:1407141526
Name:DERRICK, CHASE D (MD)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:D
Last Name:DERRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 GEORGE BUSH HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3565
Mailing Address - Country:US
Mailing Address - Phone:972-470-5000
Mailing Address - Fax:972-470-5007
Practice Address - Street 1:3201 GEORGE BUSH HWY STE 101
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3565
Practice Address - Country:US
Practice Address - Phone:972-470-5000
Practice Address - Fax:972-470-5007
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR05592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery