Provider Demographics
NPI:1205813805
Name:JESSEN, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:JESSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 4TH AVE E
Mailing Address - Street 2:STE 140A
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3155
Mailing Address - Country:US
Mailing Address - Phone:641-792-2380
Mailing Address - Fax:641-792-6184
Practice Address - Street 1:300 N 4TH AVE E
Practice Address - Street 2:STE 140A
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3155
Practice Address - Country:US
Practice Address - Phone:641-792-2380
Practice Address - Fax:641-792-6184
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA17964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0063651Medicaid
06365OtherWELLMARK
06365OtherWELLMARK
06365Medicare ID - Type Unspecified