Provider Demographics
NPI:1205030855
Name:CARON, JEAN S (DOM, AP, LMT)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:S
Last Name:CARON
Suffix:
Gender:M
Credentials:DOM, AP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E GRANADA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6634
Mailing Address - Country:US
Mailing Address - Phone:386-677-5400
Mailing Address - Fax:386-677-5420
Practice Address - Street 1:115 E GRANADA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6634
Practice Address - Country:US
Practice Address - Phone:386-677-5400
Practice Address - Fax:386-677-5420
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 35023246Z00000X
FLAP2427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other