Provider Demographics
NPI:1750417804
Name:GORMEZANO, DYANN JOY (MD)
Entity type:Individual
Prefix:DR
First Name:DYANN
Middle Name:JOY
Last Name:GORMEZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PEACOCK LN N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8333
Mailing Address - Country:US
Mailing Address - Phone:561-741-8819
Mailing Address - Fax:561-741-8817
Practice Address - Street 1:5917 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1303
Practice Address - Country:US
Practice Address - Phone:561-966-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME776962086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG99037Medicare UPIN