Provider Demographics
NPI:1013915735
Name:ROUSSERE, JUDE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:T
Last Name:ROUSSERE
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:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95038-0785
Mailing Address - Country:US
Mailing Address - Phone:408-778-5819
Mailing Address - Fax:
Practice Address - Street 1:16360 MONTEREY ST
Practice Address - Street 2:STE 270
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5496
Practice Address - Country:US
Practice Address - Phone:408-778-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-08-10
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAG32384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G323840Medicare ID - Type UnspecifiedMEDICARE
CAA45128Medicare UPIN