Doctor Name: | MR. THOMAS WILLIAM DEROCHE |
NPI Number: | 1467529735 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 5601002637 |
Business Practice Address: | 7870w Us Highway 2 Manistique, MI - 498548992 |
Business Phone Number: | 9063413200 |
Business Fax Number: | |
Mailing Address: | 7870w Us Highway 2, MANISTIQUE |
State: | MI |
Postal Code: | 498548992 |
Phone Number: | 9063413200 |
Fax Number: | |
NPI Enumeration Date: | 11/29/2006 |
NPI Last Update Date: | 08/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601002637 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |