Provider Demographics
NPI:1518932052
Name:STURM, JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:STURM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 DON WICKHAM DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1979
Mailing Address - Country:US
Mailing Address - Phone:352-241-7275
Mailing Address - Fax:352-241-7281
Practice Address - Street 1:1900 DON WICKHAM DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-241-7275
Practice Address - Fax:352-241-7281
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7662207V00000X
FLME105369207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0102575Y0NH01OtherANTHEM
NH80009396Medicaid
NHB86206Medicare UPIN
NHNH9396Medicare ID - Type Unspecified
NH80009396Medicaid