Provider Demographics
NPI:1124056015
Name:FAREMOUTH, JAMES JOSEPH JR (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:FAREMOUTH
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 1:8360 SIERRA MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7328
Mailing Address - Country:US
Mailing Address - Phone:239-624-8300
Mailing Address - Fax:239-430-7805
Practice Address - Street 1:8360 SIERRA MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7328
Practice Address - Country:US
Practice Address - Phone:239-624-8300
Practice Address - Fax:239-430-7805
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09467OtherFL BC
FLAH972XOtherMEDICARE
FL280274100Medicaid
FLAH972Medicare PIN
FLAH972XOtherMEDICARE