Provider Demographics
NPI:1952592743
Name:MARSEE, DEREK KEVIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:KEVIN
Last Name:MARSEE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 C STREET
Mailing Address - Street 2:SUITE 200-E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3363
Mailing Address - Country:US
Mailing Address - Phone:916-447-6267
Mailing Address - Fax:916-456-5842
Practice Address - Street 1:3301 C STREET
Practice Address - Street 2:SUITE 200-E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3363
Practice Address - Country:US
Practice Address - Phone:916-447-6267
Practice Address - Fax:916-456-5842
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225277207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA112407OtherCALIFORNIA MEDICAL LICENSE