Provider Demographics
NPI:1104593060
Name:DERBY, ROBERT JOHN (NP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:DERBY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BELOIT HEALTH SYSTEMS INC
Mailing Address - Street 2:1969 W HART ROAD
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2230
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5525
Practice Address - Street 1:BELOIT CLINIC
Practice Address - Street 2:1905 E HUEBBE PARKWAY
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-1640
Practice Address - Fax:608-363-7393
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2023-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209024153363L00000X
WI11369-33363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily