Provider Demographics
NPI:1760683585
Name:BARONDEAU, JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:BARONDEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247037
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-7037
Mailing Address - Country:US
Mailing Address - Phone:402-955-6935
Mailing Address - Fax:402-955-6931
Practice Address - Street 1:8552 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3567
Practice Address - Country:US
Practice Address - Phone:402-955-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24022208000000X, 2080A0000X
SDSD98812080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics