Provider Demographics
NPI:1780686345
Name:PREUDHOMME, JULES ALVA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULES
Middle Name:ALVA
Last Name:PREUDHOMME
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 1:1228 SE 8TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3210
Mailing Address - Country:US
Mailing Address - Phone:239-945-1105
Mailing Address - Fax:239-945-4495
Practice Address - Street 1:1228 SE 8TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3210
Practice Address - Country:US
Practice Address - Phone:239-945-1105
Practice Address - Fax:239-945-4495
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72077207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38762Medicare UPIN
FLE0041YMedicare ID - Type Unspecified