Provider Demographics
NPI:1316144082
Name:LEE, DERRICK CALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:CALVIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27400 HESPERIAN BLVD
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4235
Mailing Address - Country:US
Mailing Address - Phone:510-784-2069
Mailing Address - Fax:
Practice Address - Street 1:27400 HESPERIAN BLVD
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4235
Practice Address - Country:US
Practice Address - Phone:510-784-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95970207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology