Provider Demographics
NPI:1831199405
Name:DERRICK, BRUCE M (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:DERRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:599 W STATE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2567
Mailing Address - Country:US
Mailing Address - Phone:215-348-7195
Mailing Address - Fax:215-348-8633
Practice Address - Street 1:599 W STATE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2567
Practice Address - Country:US
Practice Address - Phone:215-348-7195
Practice Address - Fax:215-348-8633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD017889E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006800400003Medicaid
PA139802Medicare ID - Type Unspecified
PA0006800400003Medicaid