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General NPI Number Information
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NPI Number | 1720591894
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Entity Type | Organization
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Legal Business Name | JBH MEDICAL
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 1452 E MICHIGAN ST
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City | ORLANDO
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State | FL
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Zip | 32806-4817
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Country | US
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Telephone | 407-234-5282
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Fax | 407-650-3274
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Provider Business Mailing Address
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Address Line | 1452 E MICHIGAN ST
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City | ORLANDO
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State | FL
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Zip | 32806-4817
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Country | US
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Telephone | 407-234-5282
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Fax | 407-650-3274
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Authorized Official
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Title or Position | OWNER
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Name | JEAUDINE BONTEMPS
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Credential | MD
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Telephone | 407-619-8596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME94807
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License Number State | FL
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