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1023035524
JAMES LYLE DERICKSON
NOGALES, AZ
NPI
1023035524
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: AZ 37067)
Enumeration Date
2006-07-17
Last Update Date
2018-11-28
Business Address
JAMES LYLE DERICKSON MD
1852 N MASTICK WAY
NOGALES, AZ 85621
Phone number: 520-281-1550
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Mailing Address
JAMES LYLE DERICKSON MD
825 N GRAND AVE STE 100
NOGALES, AZ 85621-1061
Phone number: 520-761-2133
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