MEDICARE: LISSA M JEAN-PIERRE MD

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	208D00000X	General Practice Physician	ME85417	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720077019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISSA M JEAN-PIERRE MD

Provider Business Mailing Address
First Line	:	5400 PINEHURST DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-3833
Country	:	US
Telephone Number	:	352-277-5305
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	13220 BELCHER RD S UNIT 1
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-1677
Country	:	US
Telephone Number	:	727-351-4894
Fax Number	:	727-351-4897

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/02/2024

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