Basic Information
| Provider Information | |||||||||
| NPI: | 1760740708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUNZ | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 IRVING ST NW | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200103017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028778080 | ||||||||
| FaxNumber: | 2028777633 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 IRVING ST NW | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200103017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028778080 | ||||||||
| FaxNumber: | 2028777633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | M13319 | ID | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207PS0010X | 0101257966 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
No ID Information.