Provider Demographics
NPI:1750351763
Name:CATTELANE, JERRY J JR (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:CATTELANE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 SW HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3516
Mailing Address - Country:US
Mailing Address - Phone:561-846-2013
Mailing Address - Fax:561-532-1027
Practice Address - Street 1:557 SW HUNTER RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3516
Practice Address - Country:US
Practice Address - Phone:561-846-2013
Practice Address - Fax:561-532-1027
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4881562207P00000X
TXU2453207P00000X
FLU2453207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0556Medicare ID - Type Unspecified
NYH54519Medicare UPIN