Provider Demographics
NPI:1013304559
Name:DELAFONTAINE, JEAN-LUC (MD)
Entity Type:Individual
Prefix:
First Name:JEAN-LUC
Middle Name:
Last Name:DELAFONTAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W OAK ST STE 360
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4910
Mailing Address - Country:US
Mailing Address - Phone:407-846-0090
Mailing Address - Fax:407-846-0072
Practice Address - Street 1:720 W OAK ST STE 360
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4910
Practice Address - Country:US
Practice Address - Phone:407-846-0090
Practice Address - Fax:407-846-0072
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.151962208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)