Provider Demographics
NPI:1174577159
Name:TOURTELOT, JOHN BROOKE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BROOKE
Last Name:TOURTELOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:B
Other - Last Name:TOURTELOT
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1698
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1698
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1318
Practice Address - Street 1:455 PINELLAS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3354
Practice Address - Country:US
Practice Address - Phone:727-461-8300
Practice Address - Fax:727-298-6924
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88865207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00256492OtherRAILROAD MEDICARE NUMBER
FL269310100Medicaid
FL269310100Medicaid
FLP00256492OtherRAILROAD MEDICARE NUMBER