Provider Demographics
NPI:1669474219
Name:PIERRE, JUDE ANTOINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:ANTOINE
Last Name:PIERRE
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 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:5290 APPLEGATE DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4507
Practice Address - Country:US
Practice Address - Phone:352-686-3101
Practice Address - Fax:352-688-8713
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-11-30
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
FLME77112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005638500Medicaid
FLP01046798OtherRAILROAD MEDICARE ATTACHED TO GRP# DR6927
FLH18717Medicare UPIN