Provider Demographics
NPI:1629433651
Name:ABSHIRE, JESSE (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:ABSHIRE
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4505
Mailing Address - Country:US
Mailing Address - Phone:650-296-9969
Mailing Address - Fax:
Practice Address - Street 1:155 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4505
Practice Address - Country:US
Practice Address - Phone:650-296-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical