Provider Demographics
NPI:1265016075
Name:PEERY, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:PEERY
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:OFFICE OF CLINICAL ED, COLLEGE OF OSTEOPATHIC MEDICINE
Mailing Address - Street 2:11 HILLS BEACH ROAD, STELLA MARIS HALL
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-602-2779
Mailing Address - Fax:207-602-5908
Practice Address - Street 1:OFFICE OF CLINICAL ED, COLLEGE OF OSTEOPATHIC MEDICINE
Practice Address - Street 2:11 HILLS BEACH ROAD, STELLA MARIS HALL
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-602-2779
Practice Address - Fax:207-602-5908
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program