Individual
JACQUE P. LEBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5153 NORTH 9TH AVE., NEMOURS CHILDRENS CLINIC, PENSACOLA, PENSACOLA, FL 32504-8785
(850) 505-4735
(850) 505-4714
Mailing address
P.O. BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(407) 650-7129
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
2009009831
MO
207YP0228X
Pediatric Otolaryngology Physician
Primary
ME105524
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891828281
—
MO
Enumeration date
03/14/2007
Last updated
02/13/2013
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