Provider Demographics
NPI:1164476602
Name:PEAN, JULES (MD)
Entity type:Individual
Prefix:
First Name:JULES
Middle Name:
Last Name:PEAN
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 1:100 GREENLEY RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5936
Mailing Address - Country:US
Mailing Address - Phone:210-271-3204
Mailing Address - Fax:210-222-2761
Practice Address - Street 1:1907 HIGHWAY 97 E STE 230
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1538
Practice Address - Country:US
Practice Address - Phone:210-923-7342
Practice Address - Fax:210-923-7100
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2025-10-07
Deactivation Date:2025-09-10
Deactivation Code:
Reactivation Date:2025-10-06
Provider Licenses
StateLicense IDTaxonomies
CAC51988207RC0000X
TXQ1882207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00257630OtherRAILROAD
CA00C519880Medicaid
CA00C519880Medicaid
CA00C519880Medicare PIN