Provider Demographics
NPI:1720175383
Name:DESORMEAU, JUDE (MD)
Entity type:Individual
Prefix:DR
First Name:JUDE
Middle Name:
Last Name:DESORMEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8927 HYPOLUXO RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5262
Mailing Address - Country:US
Mailing Address - Phone:772-871-7800
Mailing Address - Fax:772-871-7822
Practice Address - Street 1:1860 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4828
Practice Address - Country:US
Practice Address - Phone:772-871-7800
Practice Address - Fax:772-871-7822
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME644992084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43560Medicare ID - Type Unspecified