Provider Demographics
NPI:1982750279
Name:BIEBUYCK, JEAN-CHRISTOPHE (MD)
Entity Type:Individual
Prefix:
First Name:JEAN-CHRISTOPHE
Middle Name:
Last Name:BIEBUYCK
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 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-747-3650
Mailing Address - Fax:
Practice Address - Street 1:2700 UNIVERSITY SQUARE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-253-2721
Practice Address - Fax:813-977-3720
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1273212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0922Medicaid
FL019354900Medicaid
VT0VN0922Medicaid