{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "JACQUE V LEBEAU DMD",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1401 N PALAFOX ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PENSACOLA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32501-2642",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-434-1964",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1401 N PALAFOX ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PENSACOLA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32501-2642",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-434-1964",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/05/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEBEAU",
"AuthorizedOfficialFirstName": "JACQUE",
"AuthorizedOfficialMiddleName": "VICTOR",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "850-434-1964",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "6878",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}