Provider Demographics
NPI:1326145327
Name:JESSEN, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:JESSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3805
Mailing Address - Country:US
Mailing Address - Phone:409-842-8222
Mailing Address - Fax:409-842-8244
Practice Address - Street 1:3530 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3805
Practice Address - Country:US
Practice Address - Phone:409-842-8222
Practice Address - Fax:409-842-8244
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2955207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157946801Medicaid
TX157946802Medicaid
TX121679801Medicaid
TX121679805Medicaid
TXD0125750OtherDPS
TX121679802Medicaid
IN1045971OtherINDIANA LICENSE
OK20090OtherOKLAHOMA LICENSE
OK20090OtherOKLAHOMA LICENSE
TX121679802Medicaid
OK20090OtherOKLAHOMA LICENSE
TXBJ5471901OtherDEA
TX8A2071Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ORANG
TXE69555Medicare UPIN
IN1045971OtherINDIANA LICENSE