Provider Demographics
NPI:1538263819
Name:HESSMAN, JEFFREY A (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:HESSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W 4TH ST
Mailing Address - Street 2:BUILDING C SUITE A
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4474
Mailing Address - Country:US
Mailing Address - Phone:559-674-0061
Mailing Address - Fax:559-674-5712
Practice Address - Street 1:1111 W 4TH ST
Practice Address - Street 2:BUILDING C SUITE A
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4474
Practice Address - Country:US
Practice Address - Phone:559-674-0061
Practice Address - Fax:559-674-5712
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOOOE20420213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E20420Medicaid
CA000E20420Medicaid
CA000E20423Medicare PIN
CAZZZ06299ZMedicare UPIN