Provider Demographics
NPI:1063438737
Name:SPENCER, JESSIE MOOREFIELD (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:MOOREFIELD
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSIE1
Other - Middle Name:CRAWFORD
Other - Last Name:MOOREFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5137 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4108
Mailing Address - Country:US
Mailing Address - Phone:601-991-3829
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-364-1251
Practice Address - Fax:601-364-1278
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine