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Individual

MR. JUSTIN FENNER LETOURNEAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
5565 DR MARTIN LUTHER KING JR ST N, ST PETERSBURG, FL 33703-1203
(727) 577-1203
(727) 577-0893
Mailing address
2110 58TH ST W, BRADENTON, FL 34209-5660
(941) 388-8997
(941) 306-5876

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9108503
FL
363A00000X
Physician Assistant
363AM0700X
Medical Physician Assistant
PA9108503
FL

Other

Enumeration date
05/13/2010
Last updated
06/30/2021
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