Individual
MR. EARLE M PESCATORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
61 MEMORIAL MEDICAL PKWY STE 3807, PALM COAST, FL 32164-5982
(386) 231-5386
(386) 359-2945
Mailing address
770 W GRANADA BLVD STE 101, ORMOND BEACH, FL 32174-5179
(386) 231-4519
(386) 368-8927
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036102614
IL
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
OS11075
FL
207VG0400X
Gynecology Physician
OS11075
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102614-2
—
IL
05
—
0369102614
—
IL
01
—
10123243
BLUE CROSS BLUE SHIELD
IL
01
—
101552
HEALTH ALLIANCE
IL
01
—
7648181
AETNA
IL
01
—
IL0100
JOHN DEERE
IL
Enumeration date
07/11/2005
Last updated
10/06/2025
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