Provider Demographics
NPI:1922002492
Name:ADAME, JESSIE (MD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:ADAME
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 1:3007 WOODLAND HILLS DR # 123
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1403
Mailing Address - Country:US
Mailing Address - Phone:281-359-1953
Mailing Address - Fax:281-657-6834
Practice Address - Street 1:3007 WOODLAND HILLS DR # 123
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1403
Practice Address - Country:US
Practice Address - Phone:281-359-1953
Practice Address - Fax:281-657-6834
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9743207ZP0102X, 207ZF0201X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220032975OtherRAILROAD MEDICARE
TX8A0325Medicare PIN
TXG14069Medicare UPIN