Individual
JACK G. BEAULIEU
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
657 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2666
(239) 772-4484
(239) 772-2903
Mailing address
657 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2666
(239) 772-4484
(239) 772-2903
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME 0029197
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79304
B/C B/S FLORIDA INSURANCE
FL
Enumeration date
06/21/2005
Last updated
07/08/2007
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