Doctor Name: | JACQUE P. LEBEAU |
NPI Number: | 1891828281 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 5153 North 9th Ave. Nemours Childrens Clinic, Pensacola Pensacola, FL - 325048785 |
Business Phone Number: | 8505054735 |
Business Fax Number: | 8505054714 |
Mailing Address: | P.o. Box 191, Provider Enrollment Department ROCKLAND |
State: | DE |
Postal Code: | 197320191 |
Phone Number: | 4076507129 |
Fax Number: | 3026514945 |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 02/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |