MEDICARE: Y & P HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME100694	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000N8	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1376874362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Y & P HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3524 TAMIAMI TRL
Second Line	:	SUTIE 103
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8100
Country	:	US
Telephone Number	:	941-625-1801
Fax Number	:	941-391-6796

Provider Business Practice Location Address
First Line	:	3524 TAMIAMI TRL
Second Line	:	SUTIE 103
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8100
Country	:	US
Telephone Number	:	941-625-1801
Fax Number	:	941-391-6796

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PIERRE M LEROUX
Credential	:	MD
Telephone Number	:	941-625-1801

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	03/22/2010

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Directions to “Y & P HEALTHCARE LLC ” Practice Location

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