Active NPI
Jack G. Beaulieu, M.D.
- Orthopaedic Surgery Physician
- Cape Coral, FL
National Provider Identifier
1528064086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- ME 0029197
- Practice address
- 657 Del Prado Blvd S
Cape Coral, FL 33990-2666 - Phone
- (239) 772-4484
- Fax
- (239) 772-2903
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | ME 0029197 | FL | Primary |
Addresses
Primary practice location
657 Del Prado Blvd S
Cape Coral, FL 33990-2666
Mailing address
657 Del Prado Blvd S
Cape Coral, FL 33990-2666
Phone (239) 772-4484
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79304 | Other | FL | B/C B/S FLORIDA INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 0029197 | FL | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1528064086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "657 DEL PRADO BLVD S",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339902666",
"telephone_number": "239-772-4484",
"fax_number": "239-772-2903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "657 DEL PRADO BLVD S",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339902666",
"telephone_number": "239-772-4484",
"fax_number": "239-772-2903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAULIEU",
"first_name": "JACK",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "FL",
"license": "ME 0029197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B/C B/S FLORIDA INSURANCE",
"identifier": "79304",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.