Provider Demographics
NPI:1376539510
Name:VEST, JERROLD A (MD)
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:A
Last Name:VEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6406
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-6406
Mailing Address - Country:US
Mailing Address - Phone:805-928-1731
Mailing Address - Fax:805-349-8160
Practice Address - Street 1:1010 MURRAY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-8800
Practice Address - Country:US
Practice Address - Phone:805-928-1731
Practice Address - Fax:805-349-8160
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG20745207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G207450Medicaid
CAA41051Medicare UPIN
CA00G207450Medicaid