Provider Demographics
NPI:1629097670
Name:YERKS, DERREN S
Entity Type:Individual
Prefix:
First Name:DERREN
Middle Name:S
Last Name:YERKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 CLEARVISTA PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4675
Mailing Address - Country:US
Mailing Address - Phone:317-621-2566
Mailing Address - Fax:317-621-2561
Practice Address - Street 1:8101 CLEARVISTA PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4675
Practice Address - Country:US
Practice Address - Phone:317-621-2566
Practice Address - Fax:317-621-2561
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042804A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000316819OtherANTHEM
INP00112328OtherRR MEDICARE
INM400044849Medicare PIN
INM400044855Medicare PIN
INM400044856Medicare PIN
INP00112328OtherRR MEDICARE
INF94813Medicare UPIN
INM400053748Medicare PIN
IN214230AMedicare PIN
IN000000316819OtherANTHEM
INM400044853Medicare PIN