Provider Demographics
NPI:1518916501
Name:JESTER, SHAUN PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:PATRICK
Last Name:JESTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:2241 ROMBACH AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1995
Practice Address - Country:US
Practice Address - Phone:937-283-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012463207V00000X
OH34.008226207V00000X
TXM3275207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
216985OtherUNITED HEALTHCARE FLEMMIN
217155OtherUNITED HEALTHCARE DEPHI
251860035OtherDEVON
1758602OtherPREMIER BLUE
1758602OtherKEYSTONE HEALTH PLAN WEST
251860035OtherHEALTH AMERCIA
PA1758602OtherBLUE SHIELD
93462OtherGEISINGER HEALTH
709656OtherUPMC
PA1014529640001Medicaid
191443OtherUNITED HEALTHCARE PHILIPS
MA101452964Medicaid
P00287679OtherRAILROAD MEDICARE
P00287679OtherRAILROAD MEDICARE
PA1014529640001Medicaid
93462OtherGEISINGER HEALTH
I10365Medicare UPIN