Provider Demographics
NPI:1427028505
Name:PERRAULT, JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:PERRAULT
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 1:2350 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1510
Mailing Address - Country:US
Mailing Address - Phone:941-861-3220
Mailing Address - Fax:
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3220
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 80935207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN088721800Medicaid
MN100001785OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
WI32216100Medicaid
MN100000075Medicare PIN
D80931Medicare UPIN
FL58512YMedicare PIN