Provider Demographics
NPI:1194929463
Name:REEDUS, DERRICK LAMAR SR (MD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:LAMAR
Last Name:REEDUS
Suffix:SR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1822
Mailing Address - Country:US
Mailing Address - Phone:220-564-4027
Mailing Address - Fax:
Practice Address - Street 1:1980 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1363
Practice Address - Country:US
Practice Address - Phone:220-564-7520
Practice Address - Fax:220-564-7521
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.090640208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology