Provider Demographics
NPI:1962085928
Name:BEBEAU, JOHN RUSSELL (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSELL
Last Name:BEBEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LAGO VIENTO LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-8593
Mailing Address - Country:US
Mailing Address - Phone:904-718-8508
Mailing Address - Fax:
Practice Address - Street 1:181 TOWN CENTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-4002
Practice Address - Country:US
Practice Address - Phone:512-746-2690
Practice Address - Fax:888-254-4802
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine