Provider Demographics
NPI:1962031633
Name:LEBRUN, ANNUEL
Entity Type:Individual
Prefix:DR
First Name:ANNUEL
Middle Name:
Last Name:LEBRUN
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 1:5317 CURRY FORD RD APT K202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7209
Mailing Address - Country:US
Mailing Address - Phone:678-548-1536
Mailing Address - Fax:
Practice Address - Street 1:5317 CURRY FORD RD APT K202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7209
Practice Address - Country:US
Practice Address - Phone:678-548-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEM-000456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine