Female

Dr. Marie L. Deruyter M.D.

Anesthesiology Physician in Jacksonville, FL(View on Map)

Full Name

Dr. Marie Lynne Deruyter M.D.

NPI Number

1164419453

NPI Type

Individual Provider

Gender

Female

Enumeration Date

10/01/2005

Specialties

(Taxonomies)

Code

207L00000X
207LP2900X

Primary Taxonomy

Yes
No

Licenses

State

Florida

License Number

ME62548

Contact
Information

Purpose

Mailing
Location

Address

4500 SAN PABLO RD S
4500 SAN PABLO RD S

City

Jacksonville
Jacksonville

State

FL
FL

Postal Code

32224-1865
32224-1865

Country

US
US

Telephone Number

(904) 953-2000
(904) 953-2000

Identifiers

Identifier

25484
261226700
050030329

Identifier State

FL
FL
FL

Identifier Issuer

BLUECROSS/BLUESHIELD
Unknown
RAILROAD MEDICARE

Health Information Exchange

Endpoint Type

DIRECT

Endpoint

mderuyter396380@ehrdirect.mayoclinicmsg.org

Endpoint Description

Unknown

Use

Unknown

Content Type

Unknown

Affiliation

N

Endpoint Location

4500 San Pablo Rd SJacksonville, FL322241865US

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/02/2020

Provider Address

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