Healthcare Provider Details

I. General information

NPI: 1609843937
Provider Name (Legal Business Name): JAMES GUS DEMITRACK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL GUAM FARENHOLT AVENUE, BUILDING 50
AGANA HEIGHTS GU
96910
US

IV. Provider business mailing address

PSC 455 BOX 208
FPO AP
96540-0003
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9235
  • Fax:
Mailing address:
  • Phone: 671-344-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME142445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: