Basic Information
| Provider Information | |||||||||
| NPI: | 1609895002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEJEUNE | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 WESTPARK WAY STE 210 | ||||||||
| Address2: | |||||||||
| City: | EULESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760403742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6822363656 | ||||||||
| FaxNumber: | 8558139308 | ||||||||
| Practice Location | |||||||||
| Address1: | 4107 SPICEWOOD SPRINGS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123973360 | ||||||||
| FaxNumber: | 5123437107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD.200268 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | M4280 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | M4280 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 197305908 | 05 | TX | MEDICAID | 884655 | 01 | TX | MEDICARE | OTHER | 197305901 | 05 | TX | MEDICAID |