Provider Demographics
NPI:1346801024
Name:JEAN GERIATRICS, PLLC
Entity Type:Organization
Organization Name:JEAN GERIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-276-8036
Mailing Address - Street 1:3450 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2284
Mailing Address - Country:US
Mailing Address - Phone:941-276-8036
Mailing Address - Fax:
Practice Address - Street 1:3450 ROWLAND DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2284
Practice Address - Country:US
Practice Address - Phone:941-276-8036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, InpatientGroup - Multi-Specialty