Basic Information
| Provider Information | |||||||||
| NPI: | 1194788554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMES | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 SCHENCK PKWY | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286811527 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1445 CHRISTY DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651012853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736363483 | ||||||||
| FaxNumber: | 5736365315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | FT6518736 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00375858 | 01 | MO | RR MEDICARE | OTHER | 201725702 | 05 | MO | MEDICAID |