Provider Demographics
NPI:1770997991
Name:JESSAMY, KEGAN (MBBS)
Entity type:Individual
Prefix:DR
First Name:KEGAN
Middle Name:
Last Name:JESSAMY
Suffix:
Gender:M
Credentials:MBBS
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 1345
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-1345
Mailing Address - Country:US
Mailing Address - Phone:352-742-4444
Mailing Address - Fax:352-742-4446
Practice Address - Street 1:1858 MAYO DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4320
Practice Address - Country:US
Practice Address - Phone:352-383-5200
Practice Address - Fax:352-383-3534
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161954207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology