MEDICARE: DR. DYANN JOY GORMEZANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	ME77696	FL

General Provider Information

NPI Number	:	1750417804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DYANN JOY GORMEZANO M.D.

Provider Business Mailing Address
First Line	:	500 PEACOCK LN N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-8333
Country	:	US
Telephone Number	:	561-741-8819
Fax Number	:	561-741-8817

Provider Business Practice Location Address
First Line	:	5917 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1303
Country	:	US
Telephone Number	:	561-966-3393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/08/2007

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