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