Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6878 | FL |
Y | 213EG0000X | General Practice | 6878 | FL |
NPI | 1003044843 |
---|---|
Provider Name | Jacque V Lebeau |
First Address | Pensacola, FL 32501-2642 |
Second Address | Pensacola, FL 32501-2642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 01/07/2009 |