Provider Demographics
NPI:1386790129
Name:GALAPON, DERRICK BRENT (MD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:BRENT
Last Name:GALAPON
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 1:80 ENOCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2231
Mailing Address - Country:US
Mailing Address - Phone:731-925-9909
Mailing Address - Fax:731-925-3323
Practice Address - Street 1:80 ENOCH BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2231
Practice Address - Country:US
Practice Address - Phone:731-925-9909
Practice Address - Fax:731-925-3323
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21721208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3891379Medicaid
TNIO9999Medicare UPIN
TN3891379Medicare ID - Type Unspecified