Provider Demographics
NPI:1457466658
Name:MCCARRON, JESSE A (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:MCCARRON
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 1:200 NE MOTHER JOSEPH PL
Mailing Address - Street 2:STE 210
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3295
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1139
Practice Address - Street 1:200 NE MOTHER JOSEPH PL
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3299
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:360-449-1146
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD151775207X00000X
WAMD60631095207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1457466658Medicaid
OHI57059Medicare UPIN
OHMC7357951Medicare PIN