Provider Demographics
NPI:1194956318
Name:PENDERGRAFT, JAMES S IV (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:PENDERGRAFT
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1103 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1016
Mailing Address - Country:US
Mailing Address - Phone:407-245-7999
Mailing Address - Fax:
Practice Address - Street 1:1103 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1016
Practice Address - Country:US
Practice Address - Phone:407-245-7999
Practice Address - Fax:407-650-9456
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME5907207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology