Healthcare Provider Details

I. General information

NPI: 1619908704
Provider Name (Legal Business Name): JEAN CLAUDE TABUTEAU M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S CONGRESS AVE
DELRAY BEACH FL
33445-4617
US

IV. Provider business mailing address

7023 LAKE ISLAND DR
LAKE WORTH FL
33467-7950
US

V. Phone/Fax

Practice location:
  • Phone: 561-274-3100
  • Fax: 561-274-3144
Mailing address:
  • Phone: 561-967-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME47425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: