Healthcare Provider Details

I. General information

NPI: 1700894995
Provider Name (Legal Business Name): JAMES W DERUITER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 E 15TH ST
PANAMA CITY FL
32405-6345
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-5272
  • Fax:
Mailing address:
  • Phone: 850-747-5599
  • Fax: 850-747-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0012877
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME12877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: