Basic Information
Provider Information | |||||||||
NPI: | 1457320681 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JEAN-BAPTISTE | ||||||||
FirstName: | LYONEL | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1021 HEALTH PARK DR | ||||||||
Address2: |   | ||||||||
City: | MOORE HAVEN | ||||||||
State: | FL | ||||||||
PostalCode: | 334716206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8639460405 | ||||||||
FaxNumber: | 8445428959 | ||||||||
Practice Location | |||||||||
Address1: | 1021 HEALTH PARK DR | ||||||||
Address2: |   | ||||||||
City: | MOORE HAVEN | ||||||||
State: | FL | ||||||||
PostalCode: | 334716206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8639460405 | ||||||||
FaxNumber: | 8445428959 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/17/2006 | ||||||||
LastUpdateDate: | 03/02/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/02/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME64440 | FL | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 23712 | 01 | FL | BCBS PROVIDER # | OTHER | 373638500 | 05 | FL |   | MEDICAID |