Provider Demographics
NPI:1487683991
Name:DERR, DAVID RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RONALD
Last Name:DERR
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 1:601 DODDS AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3911
Mailing Address - Country:US
Mailing Address - Phone:423-826-8220
Mailing Address - Fax:423-698-3622
Practice Address - Street 1:807 STEELS POINTE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-331-5934
Practice Address - Fax:601-815-1854
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN442042085R0202X
MS187382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00261751OtherRAILROAD MEDICARE
MS01536317Medicaid
MS512G700003OtherMS MEDCIARE - GROUP
MS01536317Medicaid
MS512G700003OtherMS MEDCIARE - GROUP
300000972Medicare ID - Type Unspecified