Provider Demographics
NPI:1750386108
Name:PIERRE, JUDE-FARLEY (DPM)
Entity type:Individual
Prefix:DR
First Name:JUDE-FARLEY
Middle Name:
Last Name:PIERRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:4655 KEYSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3516
Practice Address - Country:US
Practice Address - Phone:352-666-1913
Practice Address - Fax:352-666-1903
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2999213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00955954OtherRR MCR ATTCHED TO GRP# DR6927
FL65775OtherBCBS
FL65775OtherBLUE CROSS BLUE SHIELD
110237710OtherRAILROAD MCR WITH GROUP CH7269
NY1499565OtherGHI
NY150254OtherCHN
FL340314900Medicaid
NY02493369Medicaid
FL5443420OtherCIGNA
FL65775WMedicare PIN
FLU90093Medicare UPIN
NYPG8601Medicare ID - Type Unspecified