Provider Demographics
NPI:1396992392
Name:DERICKS, GERARD (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:DERICKS
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 1:1498 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2148
Mailing Address - Country:US
Mailing Address - Phone:510-524-1680
Mailing Address - Fax:510-528-8410
Practice Address - Street 1:1498 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2148
Practice Address - Country:US
Practice Address - Phone:510-524-1680
Practice Address - Fax:510-528-8410
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28626207X00000X
HI2486207X00000X
TXE6764207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery