DR. DUSTIN CLIFTON DERRICK (NPI# 1295049070) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295049070 |
| Entity Type | Individual |
| Full Name | DR. DUSTIN CLIFTON DERRICK |
| Credential | M.D. |
| Practice Address |
800 8th Ave Ste 206 Fort Worth TX 76104-2619 |
| Practice Telephone | 8175294314 |
| Practice Fax Number | 8173340491 |
| Mailing Telephone | 8175294314 |
| Mailing Fax Number | 8173340491 |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2018-11-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | Q4085 | TX | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | Q4085 | TX | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 57. 025880 | OH | Student, Health Care |
| Street Address |
800 8TH AVE STE 206 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-2619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851618649 | Maxim Pekarev | Plastic Surgery | 800 8th Ave Ste 206, Fort Worth, TX 76104-2619 | 2010-05-03 |
| 1194193052 | North Metro Plastic Surgery Pllc | Plastic Surgery | 800 8th Ave Ste 206, Fort Worth, TX 76104-2619 | 2015-09-09 |
| 1275922734 | Mp Plastic Surgery Pllc | Plastic Surgery | 800 8th Ave Ste 206, Fort Worth, TX 76104-2619 | 2015-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487184792 | West Magnolia Plastic Surgery Pa | Plastic Surgery | 1200 W Magnolia Ave Ste 110, Fort Worth, TX 76104-4488 | 2017-06-19 |
| 1336695857 | Steven Camp Md Plastic Surgery Pllc | Plastic Surgery | 2928 Owenwood Dr, Fort Worth, TX 76109-1613 | 2016-08-26 |
| 1851618649 | Maxim Pekarev | Plastic Surgery | 800 8th Ave Ste 206, Fort Worth, TX 76104-2619 | 2010-05-03 |
| 1114162807 | Jonathan B. Heistein, Md, Pa | Plastic Surgery | 800 8th Ave Ste 240, Fort Worth, TX 76104-2619 | 2008-12-09 |
| 1982869731 | Emily J Kirby | Plastic Surgery | 5075 Edwards Ranch Rd, Fort Worth, TX 76109-4133 | 2008-07-22 |
| 1740468404 | Danielle M. Leblanc, M.d., P.a. | Plastic Surgery | 800 8th Ave Ste 406, Fort Worth, TX 76104-2618 | 2008-02-05 |
| 1235267519 | Steven M Camp | Plastic Surgery | 3455 Locke Avenue, Suite 320, Fort Worth, TX 76107 | 2007-03-01 |
| 1356419998 | Valentin Gracia Md Pa | Plastic Surgery | 700 South Fwy, Fort Worth, TX 76104-3516 | 2006-12-01 |
| 1629010772 | Matthew Howard Steele | Plastic Surgery | 5656 Edwards Ranch Road, Suite 202, Fort Worth, TX 76109 | 2006-06-12 |
| 1730144502 | Kelly R Kunkel | Plastic Surgery | 1830 8th Ave, Fort Worth, TX 76110-1391 | 2006-04-17 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.