Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101036486 | VA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 0101036486 | VA |
NPI | 1407822604 |
---|---|
Provider Name | Douglas E Jessup |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Richmond, VA 23294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 01/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6496059 | (05) | VA |
B08409 | (02) |