Provider Demographics
NPI:1720591894
Name:JBH MEDICAL
Entity Type:Organization
Organization Name:JBH MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAUDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONTEMPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-619-8596
Mailing Address - Street 1:1452 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4817
Mailing Address - Country:US
Mailing Address - Phone:407-234-5282
Mailing Address - Fax:407-650-3274
Practice Address - Street 1:1452 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4817
Practice Address - Country:US
Practice Address - Phone:407-234-5282
Practice Address - Fax:407-650-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty