Provider Demographics
NPI:1093742603
Name:MCBETH, JESSICA C (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:C
Last Name:MCBETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:S
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:VALLEY MEDICAL CENTER, DEPT OF ORTHOPAEDICS
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-5395
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:VALLEY MEDICAL CENTER, DEPT OF ORTHOPAEDICS
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47182207X00000X
CAA97096207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0599258Medicaid
CA00A970960Medicaid
MN2372484OtherARAZ
MT0148395Medicaid
MN951550000Medicaid
MN135301OtherUCARE
MN09-02199OtherMEDICA CHOICE
MNHP54825OtherHEALTHPARTNERS
MN09-00027OtherMEDICA PRIMARY
MN1044692OtherPREFERRED ONE
MNE013OtherCHAMPUS
MN135301OtherUCARE
CA00A970960Medicaid
CA00A970960Medicare PIN