Provider Demographics
NPI:1144394800
Name:DERUIJTER, ADRIANUS J (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANUS
Middle Name:J
Last Name:DERUIJTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S. MOON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-685-0500
Mailing Address - Fax:813-681-8675
Practice Address - Street 1:1427 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2801
Practice Address - Country:US
Practice Address - Phone:813-685-0500
Practice Address - Fax:813-681-8675
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00585692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056277700Medicaid
FL11396OtherBCBS PROVIDER NUMBER
FL056277700Medicaid