Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME61020 | FL |
N | 111NI0900X | Internist | ME61020 | FL |
Y | 207RA0201X | Internist - Allergy & Immunology | ME61020 | FL |
NPI | 1477665263 |
---|---|
Provider Name | Dr. Lulu Amornmarn |
First Address | Jacksonville, FL 32256-3401 |
Second Address | Jacksonville, FL 32256-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 05/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030005313 | RAILROAD MEDICARE (01) | |
1227935 | CIGNA (01) | |
2287707 | AETNA HMO (01) | |
25126 | BLUE CROSS BLUE SHIELD (01) | FL |
375111200 | (05) | FL |
4641748 | AETNA PPO/POS (01) | |
BL140W | MEDICARE PTAN (01) | |
F80164 | (02) |