MEDICARE: JAMES LEROY BUILTEMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME95145	FL
2	2085N0700X	Neuroradiology Physician	ME95145	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00688760	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841267648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LEROY BUILTEMAN M.D.

Provider Business Mailing Address
First Line	:	224 BLUEBIRD LN
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7976
Country	:	US
Telephone Number	:	904-315-8642
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 BLUEBIRD LN
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-7976
Country	:	US
Telephone Number	:	904-315-8642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/20/2025

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Directions to “ JAMES LEROY BUILTEMAN M.D.” Practice Location

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