Provider Demographics
NPI:1992157788
Name:LEY, DEREK (DPM)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:LEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-901-4937
Mailing Address - Fax:855-217-6283
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4015
Practice Address - Fax:512-901-3935
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3122213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery