MEDICARE: JPFO LLC

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	213E00000X	Podiatrist	PO3392	FL

General Provider Information

NPI Number	:	1407234719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPFO LLC

Provider Business Mailing Address
First Line	:	145 HILDEN RD STE 103
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-8401
Country	:	US
Telephone Number	:	904-615-1853
Fax Number	:	904-615-1873

Provider Business Practice Location Address
First Line	:	145 HILDEN RD STE 103
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-8401
Country	:	US
Telephone Number	:	904-615-1853
Fax Number	:	904-615-1873

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFERSON PEARCE FUTCH
Credential	:	DPM
Telephone Number	:	904-615-1853

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	10/02/2025

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