MEDICARE: MR. EARLE M PESCATORE JR. D.O.

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	207VG0400X	Gynecology Physician	OS11075	FL
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	OS11075	FL
3	207V00000X	Obstetrics & Gynecology Physician	036102614	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101552	OTHER	IL	HEALTH ALLIANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10123243	OTHER	IL	BLUE CROSS BLUE SHIELD
4	7648181	OTHER	IL	AETNA
5	IL0100	OTHER	IL	JOHN DEERE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336147693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EARLE M PESCATORE JR. D.O.

Provider Business Mailing Address
First Line	:	770 W GRANADA BLVD STE 101
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5179
Country	:	US
Telephone Number	:	386-231-4519
Fax Number	:	386-368-8927

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 3807
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5982
Country	:	US
Telephone Number	:	386-231-5386
Fax Number	:	386-359-2945

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/06/2025

Similar Medicare Providers

1124098553 — ALLAN C OGLESBY M.D.
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 3804
PALM COAST, FL
32164-5982

Practice Phone: 386-586-1740
Practice Fax:

1386726453 — RALPH A HIGHSHAW MD
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 3807
PALM COAST, FL
32164-5982

Practice Phone: 386-586-1705
Practice Fax: 386-586-1706

1932373479 — AMIT NANAVATI MD
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 3816
PALM COAST, FL
32164-5982

Practice Phone: 386-586-4765
Practice Fax: 386-586-4769

1043459563 — MR. FERNANDO M ULLOA APRN
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 3803
PALM COAST, FL
32164-5982

Practice Phone: 718-721-1674
Practice Fax:

1134448129 — DR. MATTHEW JULIAN WIDEROFF M.D.
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 3805
PALM COAST, FL
32164-5982

Practice Phone: 386-586-1605
Practice Fax: 386-586-1607

1740586288 — MRS. KELLIE KILPATRICK BATTILLO FNP-C, ARNP
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 3805
PALM COAST, FL
32164-5982

Practice Phone: 386-586-1605
Practice Fax: 386-586-1607

Directions to “ MR. EARLE M PESCATORE JR. D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.