Provider Demographics
NPI:1558712182
Name:JEAN, ELIE (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-482-7623
Mailing Address - Fax:916-482-3647
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2867
Practice Address - Country:US
Practice Address - Phone:916-679-3590
Practice Address - Fax:916-786-7498
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2023-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA168259207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease