Provider Demographics
NPI:1902335805
Name:DERRICK CONSULTING PLLC
Entity Type:Organization
Organization Name:DERRICK CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-596-8017
Mailing Address - Street 1:3216 NE 45TH PL STE 207
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4028
Mailing Address - Country:US
Mailing Address - Phone:415-596-8017
Mailing Address - Fax:
Practice Address - Street 1:3216 NE 45TH PL STE 207
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4028
Practice Address - Country:US
Practice Address - Phone:415-596-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD60138640207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60138640OtherWASHINGTON STATE DOH