Provider Demographics
NPI:1063402402
Name:DERR, JEFFREY JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAMES
Last Name:DERR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 CENTRACARE CIR STE 1575
Mailing Address - Street 2:ST. CLOUD HOSPITAL/PLAZA REHABILITATION
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4944
Mailing Address - Fax:320-229-5156
Practice Address - Street 1:1900 CENTRACARE CIR STE 1575
Practice Address - Street 2:ST. CLOUD HOSPITAL/PLAZA REHABILITATION
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4944
Practice Address - Fax:320-229-5156
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-01-04
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Provider Licenses
StateLicense IDTaxonomies
MN55049208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN250001011Medicare PIN