Basic Information
| Provider Information | |||||||||
| NPI: | 1952592743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSEE | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 C STREET | ||||||||
| Address2: | SUITE 200-E | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164476267 | ||||||||
| FaxNumber: | 9164565842 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 C STREET | ||||||||
| Address2: | SUITE 200-E | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164476267 | ||||||||
| FaxNumber: | 9164565842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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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 | 207ZP0102X | 225277 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | A112407 | 01 | CA | CALIFORNIA MEDICAL LICENSE | OTHER |