=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750386108
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDE-FARLEY PIERRE DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2005
-----------------------------------------------------
Last Update Date | 07/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4655 KEYSVILLE AVE
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34608-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-1913
-----------------------------------------------------
Fax | 352-666-1903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 PINEHURST DR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-3833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5348
-----------------------------------------------------
Fax | 352-606-2857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | PO2999
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO2999
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------