Provider Demographics
NPI:1669434494
Name:DEUTCH, AMIE G (MD)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:G
Last Name:DEUTCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMIE
Other - Middle Name:D
Other - Last Name:GONTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4555 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4966
Practice Address - Country:US
Practice Address - Phone:904-633-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205136207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2067421Medicaid
MAJ27668OtherBCBS
MAA36891Medicare ID - Type Unspecified
MA2067421Medicaid