Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | G6535 | TX |
NPI | 1013912740 |
---|---|
Provider Name | Dr. Jesse L Jurado |
First Address | San Angelo, TX 76902-5780 |
Second Address | San Angelo, TX 76904-6883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 23/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C17660 | (02) | TX |