Provider Demographics
NPI:1992790596
Name:JEAN PIERRE, JACQUES (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:JEAN PIERRE
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 1:5547 HILLSIDE LANDING ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5547 HILLSIDE LANDING ROAD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92607208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497748743OtherGROUP NPI NUMBER / LRHSI
FL272077900Medicaid
FL30530ZMedicare PIN
FL03530OtherBCBS OF FLORIDA
FLB08163Medicare UPIN
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER