Provider Demographics
NPI:1053679365
Name:PROULX, JEAN T
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:T
Last Name:PROULX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 BEACH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3710
Mailing Address - Country:US
Mailing Address - Phone:904-398-7118
Mailing Address - Fax:904-398-7114
Practice Address - Street 1:3132 BEACH BOULEVARD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3710
Practice Address - Country:US
Practice Address - Phone:904-398-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier