Provider Demographics
NPI:1023068194
Name:HESSING, JEFFREY GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GLENN
Last Name:HESSING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8854 W EMERALD ST
Mailing Address - Street 2:STE 140
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4845
Mailing Address - Country:US
Mailing Address - Phone:208-321-4790
Mailing Address - Fax:208-321-4836
Practice Address - Street 1:8854 W EMERALD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4844
Practice Address - Country:US
Practice Address - Phone:208-327-4790
Practice Address - Fax:208-367-4888
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM4907207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005805OtherREGENCE BLUE SHIELD
IDP00297173OtherTRAVELERS MEDICARE
ID003748000Medicaid
ID49072OtherBLUE CROSS
ID49072OtherBLUE CROSS
ID1117898Medicare ID - Type Unspecified