Provider Demographics
NPI:1679836720
Name:HWU, DERRICK WAYHORNG (MD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:WAYHORNG
Last Name:HWU
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 1:350 N SAINT PAUL ST
Mailing Address - Street 2:APT 2117
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4240
Mailing Address - Country:US
Mailing Address - Phone:978-319-0100
Mailing Address - Fax:
Practice Address - Street 1:350 N SAINT PAUL ST
Practice Address - Street 2:APT 2117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4240
Practice Address - Country:US
Practice Address - Phone:978-319-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100671207P00000X
TXQ3700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine