Healthcare Provider Details

I. General information

NPI: 1154328375
Provider Name (Legal Business Name): JASON EUGENE LEMOINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E PAR ST
ORLANDO FL
32804-4003
US

IV. Provider business mailing address

303 E PAR ST
ORLANDO FL
32804-4003
US

V. Phone/Fax

Practice location:
  • Phone: 877-876-3627
  • Fax: 321-843-4101
Mailing address:
  • Phone: 877-876-3627
  • Fax: 321-843-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME89927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: