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General NPI Number Information
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NPI Number | 1386628642
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Entity Type | Individual
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Provider Name | EUGENE R BEBEAU JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 800 PRUDENTIAL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8202
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Country | US
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Telephone | 904-398-3356
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Fax | 904-398-5397
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Provider Business Mailing Address
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Address Line | 851 TRAFALGAR COURT SUITE 200E
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 407-667-0444
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Fax | 407-667-4338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME0059387
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License Number State | FL
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