Provider Demographics
NPI:1730233966
Name:PEGERON, JEAN-PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN-PAUL
Middle Name:
Last Name:PEGERON
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 1:425 E WASHINGTON ST
Mailing Address - Street 2:SUITE 104-S
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2024
Mailing Address - Country:US
Mailing Address - Phone:734-995-0101
Mailing Address - Fax:
Practice Address - Street 1:425 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2024
Practice Address - Country:US
Practice Address - Phone:734-995-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJP0350542084P0800X
MI4301035054102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2608121770OtherBCBS OF MICHIGAN
MI2608121770OtherBCBS OF MICHIGAN
MI0812177Medicare ID - Type Unspecified