Provider Demographics
NPI:1598755969
Name:VARNER, DERRICK FERDINAND (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:FERDINAND
Last Name:VARNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 78
Mailing Address - Street 2:BOX 3419
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326
Mailing Address - Country:JP
Mailing Address - Phone:01181311-755-7508
Mailing Address - Fax:
Practice Address - Street 1:374 MEDICAL GROUP/MDOS
Practice Address - Street 2:MEDICAL OPERATIONS SQUADRON
Practice Address - City:YOKOTA AIR FORCE BASE
Practice Address - State:JAPAN
Practice Address - Zip Code:96326
Practice Address - Country:JP
Practice Address - Phone:01181311-755-7508
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04381363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical