Provider Demographics
NPI:1881991545
Name:PENDER, JAMES JEROME
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JEROME
Last Name:PENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15132 WINDMILL HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6833
Mailing Address - Country:US
Mailing Address - Phone:407-929-5093
Mailing Address - Fax:407-905-5250
Practice Address - Street 1:15132 WINDMILL HARBOR CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6833
Practice Address - Country:US
Practice Address - Phone:407-929-5093
Practice Address - Fax:407-905-5250
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator