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1962085928 NPI number — JOHN RUSSELL BEBEAU DO

NPI Number: 1962085928
Health Care Provider/Practitioner: JOHN RUSSELL BEBEAU DO

Information about “1962085928” NPI (JOHN RUSSELL BEBEAU DO) exists in 1962085928 in HTML format HTML  |  1962085928 in plain Text format TXT  |  1962085928 in PDF (Portable Document Format) PDF  |  1962085928 in an XML format XML  formats.

NPI Number : 1962085928 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962085928",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEBEAU",
    "FirstName": "JOHN",
    "MiddleName": "RUSSELL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16 LAGO VIENTO LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76513-8593",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-718-8508",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "181 TOWN CENTER BLVD STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JARRELL",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76537-4002",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-746-2690",
    "PracticeLocationAddressFaxNumber": "888-254-4802",
    "EnumerationDate": "04/28/2021",
    "LastUpdateDate": "01/09/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "V0346",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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