MEDICARE: MR. JACQUES JEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2279H0200X	Home Health Registered Respiratory Therapist	RT6007	FL

General Provider Information

NPI Number	:	1013002633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACQUES JEAN

Provider Business Mailing Address
First Line	:	12790 N.E 5TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-4706
Country	:	US
Telephone Number	:	305-807-0137
Fax Number	:

Provider Business Practice Location Address
First Line	:	12790 N.E 5TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-4706
Country	:	US
Telephone Number	:	305-807-0137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/09/2007

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