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General NPI Number Information
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NPI Number | 1629620034
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Entity Type | Individual
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Provider Name | JEAN B PIERRE
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Gender | Male
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 5924 ITHACA CIR W
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City | LAKE WORTH
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State | FL
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Zip | 33463-1518
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Country | US
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Telephone | 561-255-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 ITHACA CIR W
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City | LAKE WORTH
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State | FL
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Zip | 33463-1518
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 265-P.A
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8416
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License Number State | AZ
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