Provider Demographics
NPI:1508094665
Name:DEJESUS, MA ROSARIO S
Entity Type:Individual
Prefix:DR
First Name:MA ROSARIO
Middle Name:S
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2176
Mailing Address - Country:US
Mailing Address - Phone:812-524-8388
Mailing Address - Fax:812-524-8445
Practice Address - Street 1:113 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2176
Practice Address - Country:US
Practice Address - Phone:812-524-8388
Practice Address - Fax:812-524-8445
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070844A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine