Provider Demographics
NPI:1013159102
Name:DEERY, DAVID THOMAS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
Last Name:DEERY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:SHRINERS HOSPITAL FOR CHILDREN PHILADELPHIA
Mailing Address - Street 2:LOCKBOX #7642 - PO BOX 8500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:3551 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4160
Practice Address - Country:US
Practice Address - Phone:215-430-4022
Practice Address - Fax:215-430-4079
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2010-07-21
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Provider Licenses
StateLicense IDTaxonomies
PAMT2222222363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics