Healthcare Provider Details

I. General information

NPI: 1669434494
Provider Name (Legal Business Name): AMIE G DEUTCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE D GONTHIER MD

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 EMERSON ST
JACKSONVILLE FL
32207-4966
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number205136
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: