Provider Demographics
NPI:1386604395
Name:PRESLEY, JAMES JETROW (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JETROW
Last Name:PRESLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9576 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4217
Mailing Address - Country:US
Mailing Address - Phone:772-337-4000
Mailing Address - Fax:844-543-0396
Practice Address - Street 1:9576 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4217
Practice Address - Country:US
Practice Address - Phone:772-337-4000
Practice Address - Fax:844-543-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA66393Medicare UPIN
FL12703ZMedicare PIN