Deruyter, Marie Lynne

Deruyter, Marie Lynne is an individual health care provider with primary practice located at 4500 San Pablo Rd S , Jacksonville FL 32224-1865. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Anesthesiology is her primary health care specialty. Deruyter, Marie Lynne can be contacted via phone (904) 953-2000.

Contact Information

Primary practice address
4500 San Pablo Rd S Jacksonville FL 32224-1865
Phone: (904) 953-2000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X ME62548 Florida
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X ME62548 Florida

Profile Details

NPI number 1164419453
LBN Legal business name Deruyter, Marie Lynne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 1st, 2005
Last updated Sep 2nd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164419453 NPPES
Florida Other 25484 BLUECROSS/BLUESHIELD
Florida MEDICAID 261226700 BLUECROSS/BLUESHIELD
Florida Other 050030329 BLUECROSS/BLUESHIELD

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