MEDICARE: DR. JACQUES 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	208600000X	Surgery Physician	ME92607	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

General Provider Information

NPI Number	:	1992790596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUES JEAN PIERRE MD

Provider Business Mailing Address
First Line	:	5547 HILLSIDE LANDING ROAD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-4543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5547 HILLSIDE LANDING ROAD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-4543
Country	:	US
Telephone Number	:	863-687-1259
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/04/2020

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