Provider Demographics
NPI:1578520425
Name:JESSIE, ADRIAN CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:CRAIG
Last Name:JESSIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2498 COUNTY ROAD 411
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-7614
Mailing Address - Country:US
Mailing Address - Phone:936-462-7575
Mailing Address - Fax:936-462-7274
Practice Address - Street 1:1407 N. UNIVERSITY DR
Practice Address - Street 2:STE C
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-462-7575
Practice Address - Fax:936-462-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1258667-07Medicaid
TX1258667-05Medicaid
TXF18135Medicare UPIN
TX1258667-07Medicaid