Healthcare Provider Details

I. General information

NPI: 1841267648
Provider Name (Legal Business Name): JAMES LEROY BUILTEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 BLUEBIRD LN
SAINT AUGUSTINE FL
32080-7976
US

IV. Provider business mailing address

224 BLUEBIRD LN
SAINT AUGUSTINE FL
32080-7976
US

V. Phone/Fax

Practice location:
  • Phone: 904-315-8642
  • Fax:
Mailing address:
  • Phone: 904-315-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME95145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME95145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: