Provider Demographics
NPI:1447281530
Name:DELAMERENS, GOAR (MD)
Entity type:Individual
Prefix:
First Name:GOAR
Middle Name:
Last Name:DELAMERENS
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:904-794-2464
Mailing Address - Fax:
Practice Address - Street 1:3700 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7150
Practice Address - Country:US
Practice Address - Phone:904-794-2464
Practice Address - Fax:904-824-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOY373OtherHF MEDICARE
49792OtherBLUE CROSS / SHIELD
H07428Medicare UPIN