Provider Demographics
NPI:1649291667
Name:SPELL, DERRICK WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:WAYNE
Last Name:SPELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 84460
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-4460
Mailing Address - Country:US
Mailing Address - Phone:225-526-0018
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4950 ESSEN LN
Practice Address - Street 2:SUITE 500
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3738
Practice Address - Country:US
Practice Address - Phone:225-767-1311
Practice Address - Fax:225-767-1335
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.023882207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485918Medicaid
H72484Medicare UPIN
LA1485918Medicaid
H72484Medicare UPIN