Provider Demographics
NPI:1003054909
Name:JESSE C. DELEE, MD, PA
Entity Type:Organization
Organization Name:JESSE C. DELEE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-579-3654
Mailing Address - Street 1:PO BOX 9191
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9191
Mailing Address - Country:US
Mailing Address - Phone:210-351-6500
Mailing Address - Fax:210-351-6509
Practice Address - Street 1:5307 BROADWAY ST
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5743
Practice Address - Country:US
Practice Address - Phone:210-579-3654
Practice Address - Fax:210-579-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206311701Medicaid
TX206311701Medicaid