Provider Demographics
NPI:1124111224
Name:JEAN, JEAN CLAUDE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN CLAUDE
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8686 DAYSTAR RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7844
Mailing Address - Country:US
Mailing Address - Phone:561-739-8968
Mailing Address - Fax:
Practice Address - Street 1:5355 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2825
Practice Address - Country:US
Practice Address - Phone:954-570-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00773611Medicaid
FL54344Medicare PIN
NYA64966Medicare UPIN