Organization Active NPI

Medigyne Associates CH

  • Gynecology Physician
  • Panama City, FL
National Provider Identifier
1225214182
Registry record updated Oct 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
ME0012877 Issued in FL
Legal business name
MEDIGYNE ASSOCIATES CH
Practice address
2202 State Ave Ste 311
Panama City, FL 32405-4590
Phone
(850) 747-4963
Fax
(850) 747-0074
NPI assigned
Jan 10, 2008
Last updated
Oct 19, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James William Deruiter, M.D.
Title
President
Phone
(850) 747-4963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X ME0012877 FL Primary

Addresses

Primary practice location

2202 State Ave Ste 311
Panama City, FL 32405-4590

Mailing address

2202 State Ave Ste 311
Panama City, FL 32405-4590
Phone (850) 747-4963

Other identifiers 1

IdentifierTypeStateIssuer
066314000MedicaidFL

National Provider Directory

National Provider Directory

Locations

2202 State Ave
Ste 311
Panama City, FL 32405
Phone (850) 747-4963

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287446400000",
    "number": "1225214182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 STATE AVE STE 311",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054590",
            "telephone_number": "850-747-4963",
            "fax_number": "850-747-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 STATE AVE STE 311",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054590",
            "telephone_number": "850-747-4963",
            "fax_number": "850-747-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIGYNE ASSOCIATES CH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2010-10-19",
        "status": "A",
        "authorized_official_last_name": "DERUITER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-747-4963",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "FL",
            "license": "ME0012877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066314000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.