Provider Demographics
NPI:1821626748
Name:PRIESTER, JOHN HENRY JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:PRIESTER
Suffix:JR
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 1:6117 MAGAZINE ST APT C
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5825
Mailing Address - Country:US
Mailing Address - Phone:805-448-2040
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF VERMONT MEDICAL CENTER
Practice Address - Street 2:111 COLCHESTER AVENUE
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VT042-0016999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program