Individual
DR. THOMAS ANTHONY LEBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1 SAINT JOHNS MEDICAL PARK DR, ST AUGUSTINE, FL 32086-5300
(904) 824-0869
(904) 826-0966
Mailing address
1 SAINT JOHNS MEDICAL PARK DR, ST AUGUSTINE, FL 32086-5300
(904) 824-0869
(904) 826-0966
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
5901001508
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3385
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001262300
—
FL
01
—
480F37288
BLUE CROSS/BLUE SHIELD
MI
05
—
5184027
—
MI
01
—
P00408087
RAILROAD MEDICARE
MI
Enumeration date
05/15/2007
Last updated
10/18/2011
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