Provider Demographics
NPI:1184076069
Name:PAWICH, DEREK ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALAN
Last Name:PAWICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2326 S CONGRESS AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7652
Mailing Address - Country:US
Mailing Address - Phone:561-433-5577
Mailing Address - Fax:561-275-2696
Practice Address - Street 1:2326 S CONGRESS AVE STE 1A
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7652
Practice Address - Country:US
Practice Address - Phone:561-433-5577
Practice Address - Fax:561-275-2696
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006746213ES0103X
FLPO4088213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery