Basic Information
| Provider Information | |||||||||
| NPI: | 1750386108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERRE | ||||||||
| FirstName: | JUDE-FARLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 MARINER BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346092492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526661913 | ||||||||
| FaxNumber: | 3526661903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | PO2999 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 340314900 | 05 | FL | MEDICAID | 65775 | 01 | FL | BCBS | OTHER | 02493369 | 05 | NY | MEDICAID | 110237710 | 01 | RAILROAD MCR WITH GROUP CH7269 | OTHER | 5443420 | 01 | FL | CIGNA | OTHER | P00955954 | 01 | FL | RR MCR ATTCHED TO GRP# DR6927 | OTHER | 150254 | 01 | NY | CHN | OTHER | 1499565 | 01 | NY | GHI | OTHER | 65775 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |