MEDICARE: JEAN B PIERRE

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	363A00000X	Physician Assistant	265-P.A	PR
2	363A00000X	Physician Assistant	8416	AZ

General Provider Information

NPI Number	:	1629620034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN B PIERRE

Provider Business Mailing Address
First Line	:	5924 ITHACA CIR W
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-1518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 ITHACA CIR W
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-1518
Country	:	US
Telephone Number	:	561-255-2227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	02/06/2023

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Directions to “ JEAN B PIERRE ” Practice Location

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