=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265989081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEREK J LEJEUNE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2016
-----------------------------------------------------
Last Update Date | 09/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8380 WARREN PKWY BLD 7 STE 700
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-4198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-581-9800
-----------------------------------------------------
Fax | 972-532-3219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6710 VIRGINIA PKWY STE 215-128
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-5514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-581-9800
-----------------------------------------------------
Fax | 972-532-3219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER LYNN ODEN
-----------------------------------------------------
Credential | CPC, CHC
-----------------------------------------------------
Telephone | 972-581-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------