Provider Demographics
NPI:1730457722
Name:LOUIS JEUNE, ANDERSON
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:
Last Name:LOUIS JEUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7866 SPRINGFIELD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7895
Mailing Address - Country:US
Mailing Address - Phone:561-729-3698
Mailing Address - Fax:
Practice Address - Street 1:7866 SPRINGFIELD LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7895
Practice Address - Country:US
Practice Address - Phone:561-729-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPBCVH3503172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver