DERRICK LAVAR RAYSOR IDC
NPI 1942512231
Military Health Care Provider - Independent Duty Corpsman in Jacksonville, FL

Q: What is Derrick Raysor's NPI number?

The NPI number for Derrick Raysor is 1942512231. It was assigned to this individual provider in the NPPES registry on July 2, 2010.

Q: What is Derrick Raysor's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

Q: When was this NPI record last updated?

The NPPES record for Derrick Raysor was last updated on April 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 02, 2010

2104 MASSEY AVE, JACKSONVILLE, FL 32228(904) 270-4233 Get Directions Write a Review

NPPES record last updated: April 5, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Derrick Lavar Raysor Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERRICK LAVAR RAYSOR IDC (NPI 1942512231) is an individual independent duty corpsman provider in Jacksonville, Florida and active in the NPI registry since July 2010. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1942512231

Entity TypeIndividualMale

Primary Taxonomy1710I1002X

Provider Legal NameDERRICK LAVAR RAYSORCredential: IDC

Location Address2104 MASSEY AVEJacksonville, FL 32228

Mailing Address10088 Kit Fox PkwyJacksonville, FL 32222-4188 · (904) 686-6040

Phone(904) 270-4233

Sole ProprietorNo

Enumeration DateJuly 2, 2010

Last NPPES UpdateApril 5, 2019

✔ NPI 1942512231 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers

Taxonomy Code1710I1002X

Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.

2104 MASSEY AVE, Jacksonville, FL 32228

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Secondary Practice Locations 2

Location 11212 E 1st St Apt 88Jacksonville, FL 32206-5338 · Phone (904) 686-6040

Location 22080 Child StJacksonville, FL 32214-5338 · Phone (904) 542-7300

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FAROOQ DAVID BURHAM PHARMD

Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)

2104 MASSEY AVE
JACKSONVILLE, FL 32228

Duval County (904) 270-4280

STEPHANIE CLAIRE LAWLER CRDH

Dental Hygienist

2104 MASSEY AVE, ROOM 2065
MAYPORT NAVAL STA, FL 32228

Duval County (904) 270-4460

DANIELLE BLEVINS

Dental Hygienist

2104 MASSEY AVE
JACKSONVILLE, FL 32228

Duval County (904) 339-1930

DR. JAMES WALSH DO

Family Medicine

2104 MASSEY AVE, AVIATION MEDICINE
JACKSONVILLE, FL 32228

Duval County (904) 270-4343

JUSTIN HOBLET

Physical Therapist

2104 MASSEY AVE
JACKSONVILLE, FL 32228

Duval County (904) 270-4265

AMANDA MARIE KERLIN CRDH

Dental Hygienist

2104 MASSEY AVE
JACKSONVILLE, FL 32228

Duval County (904) 270-4460

POMPILIO PEREZ ARNP

Nurse Practitioner (Family)

2104 MASSEY AVE, BUILDING 2104
JACKSONVILLE, FL 32228

Duval County (904) 270-4303

MS. JENNIFER KEESE SCHANTZ CNM

Advanced Practice Midwife

2104 MASSEY AVE, BUILDING 2104
JACKSONVILLE, FL 32228

Duval County (904) 270-4270

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derrick Raysor's NPI number?

The NPI number for Derrick Raysor is 1942512231. It was assigned to this individual provider in the NPPES registry on July 2, 2010.

Where is Derrick Raysor located?

Derrick Raysor practices at 2104 Massey Ave, Jacksonville, FL 32228. The listed phone number is (904) 270-4233.

What is Derrick Raysor's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Derrick Raysor was last updated on April 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.