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General NPI Number Information
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NPI Number | 1992810048
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Entity Type | Individual
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Provider Name | JEAN-CLAUDE DESMANGLES M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5153 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8785
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Country | US
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Telephone | 850-505-4700
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Fax | 850-505-4711
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Provider Business Mailing Address
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Address Line | 10140 CENTURION PKWY N PROVIDER ENROLLMENT DEPARTMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0532
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Country | US
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Telephone | 904-697-4127
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Fax | 904-697-5102
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 21660
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | ME128277
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License Number State | FL
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