1750386108 NPI number — DR. JUDE-FARLEY PIERRE DPM

Table of content: DR. JUDE-FARLEY PIERRE DPM (NPI 1750386108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750386108 NPI number — DR. JUDE-FARLEY PIERRE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERRE
Provider First Name:
JUDE-FARLEY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750386108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4265 BRAEMERE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-0682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-417-8674
Provider Business Mailing Address Fax Number:
352-606-2857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4655 KEYSVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34608-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-666-1913
Provider Business Practice Location Address Fax Number:
352-666-1903
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  PO2999 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO2999 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 340314900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65775 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 02493369 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5443420 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00955954 . This is a "RR MCR ATTCHED TO GRP# DR6927" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110237710 . This is a "RAILROAD MCR WITH GROUP CH7269" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65775 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1499565 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 150254 . This is a "CHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 340314900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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