Provider Demographics
NPI:1174673685
Name:VREDENBURGH, JESSE WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:WILLIAM
Last Name:VREDENBURGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:745 KINGS POINT HBR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78402-1713
Mailing Address - Country:US
Mailing Address - Phone:361-563-4325
Mailing Address - Fax:361-880-4096
Practice Address - Street 1:24624 INTERSTATE 45 N STE 125
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4084
Practice Address - Country:US
Practice Address - Phone:832-688-6111
Practice Address - Fax:832-365-6132
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ18042083X0100X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice