Provider Demographics
NPI:1164414900
Name:FOUCAULD, JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:FOUCAULD
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:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-0939
Mailing Address - Country:US
Mailing Address - Phone:561-793-6100
Mailing Address - Fax:561-793-1974
Practice Address - Street 1:3347 STATE ROAD 7
Practice Address - Street 2:STE. 203
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8095
Practice Address - Country:US
Practice Address - Phone:561-793-6100
Practice Address - Fax:561-793-1974
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61532207RC0000X
FLME0061532207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374891000Medicaid
FLF26009Medicare UPIN
F26009Medicare UPIN
FL23945AMedicare Oscar/Certification