Provider Demographics
NPI:1710113337
Name:CHING, JESSICA ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALLEN
Last Name:CHING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100108
Mailing Address - Street 2:J402
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0138
Mailing Address - Country:US
Mailing Address - Phone:352-273-8670
Mailing Address - Fax:352-273-8639
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0138
Practice Address - Country:US
Practice Address - Phone:352-273-8670
Practice Address - Fax:352-273-8639
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1112262086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018721100Medicaid
FLIS181ZMedicare PIN