Provider Demographics
NPI:1104051598
Name:JESTER, ADAM F (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:F
Last Name:JESTER
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 1:13837 CIRCA CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4382
Mailing Address - Country:US
Mailing Address - Phone:813-684-2663
Mailing Address - Fax:813-658-6222
Practice Address - Street 1:13837 CIRCA CROSSING DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4382
Practice Address - Country:US
Practice Address - Phone:813-684-2663
Practice Address - Fax:813-658-6222
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124140207X00000X
CAA130964207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015275300Medicaid