Provider Demographics
NPI:1598027765
Name:PACE, JESSE WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:WILLIAM
Last Name:PACE
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 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-0017
Mailing Address - Country:US
Mailing Address - Phone:828-668-6435
Mailing Address - Fax:833-913-2496
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-0017
Practice Address - Country:US
Practice Address - Phone:828-668-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine