Healthcare Provider Details

I. General information

NPI: 1093007452
Provider Name (Legal Business Name): JORDAN LEJEUNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/19/2023
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

IV. Provider business mailing address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-8888
  • Fax: 406-731-8876
Mailing address:
  • Phone: 406-731-8888
  • Fax: 406-731-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD461443
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number302381
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number302381
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number57841
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: