Provider Demographics
NPI:1922443829
Name:JOHN, JEREESH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREESH
Middle Name:T
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEREESH
Other - Middle Name:T
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4110 ROYAL PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2370
Mailing Address - Country:US
Mailing Address - Phone:914-378-7000
Mailing Address - Fax:
Practice Address - Street 1:4110 ROYAL PLANTATION LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2370
Practice Address - Country:US
Practice Address - Phone:914-378-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY276222-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty