Provider Demographics
NPI:1477665263
Name:AMORNMARN, LULU (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LULU
Middle Name:
Last Name:AMORNMARN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 CHESTER LAKE RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3401
Mailing Address - Country:US
Mailing Address - Phone:904-613-8049
Mailing Address - Fax:
Practice Address - Street 1:8218 CHESTER LAKE RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3401
Practice Address - Country:US
Practice Address - Phone:904-613-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61020207RA0201X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4641748OtherAETNA PPO/POS
030005313OtherRAILROAD MEDICARE
FL25126OtherBLUE CROSS BLUE SHIELD
BL140WOtherMEDICARE PTAN
2287707OtherAETNA HMO
1227935OtherCIGNA
FL375111200Medicaid
2287707OtherAETNA HMO