MEDICARE: DR. JULES ALVA PREUDHOMME MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME72077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780686345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULES ALVA PREUDHOMME MD

Provider Business Mailing Address
First Line	:	1228 SE 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3210
Country	:	US
Telephone Number	:	239-945-1105
Fax Number	:	239-945-4495

Provider Business Practice Location Address
First Line	:	1228 SE 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3210
Country	:	US
Telephone Number	:	239-945-1105
Fax Number	:	239-945-4495

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/06/2019

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