Provider Demographics
NPI:1699113605
Name:LEBEAU CLINIC PL
Entity type:Organization
Organization Name:LEBEAU CLINIC PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACIAL PLASTIC SURGEON/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-308-1738
Mailing Address - Street 1:1020 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3118
Mailing Address - Country:US
Mailing Address - Phone:850-308-1738
Mailing Address - Fax:850-308-5420
Practice Address - Street 1:1020 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3118
Practice Address - Country:US
Practice Address - Phone:850-308-1738
Practice Address - Fax:850-308-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105524207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty