Provider Demographics
NPI:1104027382
Name:DUGGER, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:DUGGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-472-2922
Mailing Address - Fax:
Practice Address - Street 1:564 S DORA ST
Practice Address - Street 2:SUITE B2
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5486
Practice Address - Country:US
Practice Address - Phone:707-467-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver