Provider Demographics
NPI:1699014464
Name:NYE, DERIC H (DO)
Entity type:Individual
Prefix:
First Name:DERIC
Middle Name:H
Last Name:NYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W EUGIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1256
Mailing Address - Country:US
Mailing Address - Phone:602-865-4510
Mailing Address - Fax:602-865-6100
Practice Address - Street 1:5601 W EUGIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1256
Practice Address - Country:US
Practice Address - Phone:602-865-4510
Practice Address - Fax:602-865-6100
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17398207XP3100X
AZ009320207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699014464Medicaid