Active NPI
Marc H Jean, AGENT
- Contractor
- Lehigh Acres, FL
National Provider Identifier
1649902578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 19579757
- Practice address
- 3210 35TH St W
Lehigh Acres, FL 33971-0725 - Phone
- (123) 936-2466
- NPI assigned
- Jun 29, 2022
- Last updated
- Jun 29, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 19579757 | FL | Primary |
Addresses
Primary practice location
3210 35TH St W
Lehigh Acres, FL 33971-0725
Mailing address
3210 35TH St W
Lehigh Acres, FL 33971-0725
Phone (123) 936-2466
Other practice location 1
3900 Broadway
Fort Myers, FL 33901-8193
Phone (239) 449-6882
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19579757 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1649902578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 35TH ST W",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339710725",
"telephone_number": "123-936-2466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3210 35TH ST W",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339710725",
"telephone_number": "123-936-2466"
}
],
"practiceLocations": [
{
"address_1": "3900 Broadway",
"address_purpose": "LOCATION",
"city": "Fort Myers",
"state": "FL",
"postal_code": "339018193",
"country_code": "US",
"telephone_number": "239-449-6882",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JEAN",
"first_name": "MARC",
"middle_name": "H",
"credential": "AGENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-29",
"last_updated": "2022-06-29",
"certification_date": "2022-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "19579757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lehigh Acres, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.