Healthcare Provider Details

I. General information

NPI: 1538125448
Provider Name (Legal Business Name): ERIC JEAN LESPES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SAWTOOTH DR
FAYETTEVILLE NC
28314-4536
US

IV. Provider business mailing address

250-23 SAWTOOTH DR
FAYETTEVILLE NC
28314-7906
US

V. Phone/Fax

Practice location:
  • Phone: 910-213-4721
  • Fax:
Mailing address:
  • Phone: 910-213-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00045402
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: