Healthcare Provider Details

I. General information

NPI: 1184874745
Provider Name (Legal Business Name): ASSOCIATES IN INTERNAL MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32086-7150
US

IV. Provider business mailing address

3700 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32086-7150
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-2464
  • Fax:
Mailing address:
  • Phone: 904-794-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME78888
License Number StateFL

VIII. Authorized Official

Name: DR. GOAR DELAMERENS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-794-2464