Provider Demographics
NPI:1881009835
Name:DAVIDSON, JESSE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:T
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-9889
Mailing Address - Fax:314-361-4197
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV SURG TRANSPLANT
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-747-9889
Practice Address - Fax:314-361-4197
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
MO2016008739208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200061155Medicaid