Provider Demographics
NPI:1235107657
Name:LETELLIER, JEAN-PIERRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-PIERRE
Middle Name:
Last Name:LETELLIER
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 1:1004 HOBBS HWY
Mailing Address - Street 2:STE 4
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3300
Mailing Address - Country:US
Mailing Address - Phone:432-758-4960
Mailing Address - Fax:432-758-4979
Practice Address - Street 1:1004 HOBBS HWY
Practice Address - Street 2:STE 4
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3300
Practice Address - Country:US
Practice Address - Phone:432-758-4960
Practice Address - Fax:432-758-4979
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3003207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025PTOtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TX141430OtherSUPERIOR CHIPS
TX178909105Medicaid
TX178909106OtherMEDICAID HEALTHSTEPS
TX178909106OtherMEDICAID HEALTHSTEPS
TX0025PTOtherBLUE CROSS AND BLUE SHIELD OF TEXAS