Provider Demographics
NPI:1932527975
Name:WHITE, JESSICA JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JUNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-6006
Mailing Address - Fax:708-216-2683
Practice Address - Street 1:330 MOUNT AUBURN ST DEPT OF
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5075
Practice Address - Fax:617-499-5196
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145063207L00000X
IL125065982207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology