Provider Demographics
NPI:1942384136
Name:LESLY JEAN, M.D., P.A.
Entity Type:Organization
Organization Name:LESLY JEAN, M.D., P.A.
Other - Org Name:L. J. MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-781-3122
Mailing Address - Street 1:321 W ATLANTIC BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6048
Mailing Address - Country:US
Mailing Address - Phone:954-781-3122
Mailing Address - Fax:954-781-0860
Practice Address - Street 1:321 W ATLANTIC BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6048
Practice Address - Country:US
Practice Address - Phone:954-781-3122
Practice Address - Fax:954-781-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty