| Doctor Name: | JEROLD J. FADEM |
| NPI Number: | 1356482061 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME 8351 |
| Business Practice Address: | 2648 W State Road 434 Suite C Longwood, FL - 327794440 |
| Business Phone Number: | 4077887778 |
| Business Fax Number: | 4077887770 |
| Mailing Address: | 2648 W State Road 434, Suite C LONGWOOD |
| State: | FL |
| Postal Code: | 327794440 |
| Phone Number: | 4077887778 |
| Fax Number: | 4077887770 |
| NPI Enumeration Date: | 02/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 8351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |