Provider Demographics
NPI:1790014835
Name:HESS, JEFFERY ELWOOD (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ELWOOD
Last Name:HESS
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30400 MOUND RD
Mailing Address - Street 2:MANUFACTURING BLDG. C
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2029
Mailing Address - Country:US
Mailing Address - Phone:586-986-1150
Mailing Address - Fax:
Practice Address - Street 1:30400 MOUND RD
Practice Address - Street 2:MANUFACTURING BLDG. C
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2029
Practice Address - Country:US
Practice Address - Phone:586-986-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064406207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF74905Medicare UPIN