Individual
DR. MARIE LYNNE DERUYTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME62548
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
ME62548
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050030329
RAILROAD MEDICARE
FL
01
—
25484
BLUECROSS/BLUESHIELD
FL
05
—
261226700
—
FL
Enumeration date
10/01/2005
Last updated
09/02/2020
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