Provider Demographics
NPI:1871182568
Name:NAST, DEREK REID
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:REID
Last Name:NAST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 N COLORADO BLVD UNIT 127
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3814
Mailing Address - Country:US
Mailing Address - Phone:719-468-3851
Mailing Address - Fax:
Practice Address - Street 1:3999 N COLORADO BLVD UNIT 127
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3814
Practice Address - Country:US
Practice Address - Phone:719-468-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty