Provider Demographics
NPI:1194788554
Name:TOMES, MD, DEREK LEE (MD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:LEE
Last Name:TOMES, MD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SOAPSTONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-6542
Mailing Address - Country:US
Mailing Address - Phone:828-691-1175
Mailing Address - Fax:
Practice Address - Street 1:3735 GLENLAKE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6846
Practice Address - Country:US
Practice Address - Phone:704-749-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFT6518736207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00375858OtherRR MEDICARE
MO201725702Medicaid
I57602Medicare UPIN
MO201725702Medicaid