Provider Demographics
NPI:1013957182
Name:JESTER, DAVID C (DO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:JESTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N H ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2535
Mailing Address - Country:US
Mailing Address - Phone:360-537-6113
Mailing Address - Fax:360-537-6146
Practice Address - Street 1:915 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1006
Practice Address - Country:US
Practice Address - Phone:360-537-6113
Practice Address - Fax:360-537-6146
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000936207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8100331Medicaid
WAAB12203Medicare ID - Type Unspecified
WA8100331Medicaid