Basic Information
| Provider Information | |||||||||
| NPI: | 1467422402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERVAY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 MASTERS DR | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775735805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813340223 | ||||||||
| FaxNumber: | 2813340223 | ||||||||
| Practice Location | |||||||||
| Address1: | NASA JOHNSON SPACE CENTER FLIGHT MEDICINE CLINIC | ||||||||
| Address2: | 2101 NASA ROAD ONE | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814837999 | ||||||||
| FaxNumber: | 2814833392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 08/24/2010 | ||||||||
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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 | 207P00000X | J6917 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0005X | J6917 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 2083A0100X | J6917 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
No ID Information.