Healthcare Provider Details

I. General information

NPI: 1750351763
Provider Name (Legal Business Name): JERRY J CATTELANE JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 SW HUNTER RD
LAKE CITY FL
32024-3516
US

IV. Provider business mailing address

557 SW HUNTER RD
LAKE CITY FL
32024-3516
US

V. Phone/Fax

Practice location:
  • Phone: 561-846-2013
  • Fax: 561-532-1027
Mailing address:
  • Phone: 561-846-2013
  • Fax: 561-532-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10161
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4881562
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberU2453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: