Provider Demographics
NPI:1891982369
Name:JEFFREY HESSMAN DPM, INC.
Entity Type:Organization
Organization Name:JEFFREY HESSMAN DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (PODIATRIST)
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-674-0061
Mailing Address - Street 1:1111 W 4TH ST
Mailing Address - Street 2:BLDG C SUITE A
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4474
Mailing Address - Country:US
Mailing Address - Phone:559-674-0061
Mailing Address - Fax:559-674-5712
Practice Address - Street 1:1111 W 4TH ST
Practice Address - Street 2:BLDG C SUITE A
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4474
Practice Address - Country:US
Practice Address - Phone:559-674-0061
Practice Address - Fax:559-674-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E20420213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E20420Medicaid
CAZZZ06299ZMedicare PIN
CAT11151Medicare UPIN