Provider Demographics
NPI:1063519098
Name:DIAGNOSTIC PATHOLOGY ASSOCIATES, LLP
Entity type:Organization
Organization Name:DIAGNOSTIC PATHOLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-842-8222
Mailing Address - Street 1:3530 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3805
Mailing Address - Country:US
Mailing Address - Phone:409-842-8222
Mailing Address - Fax:409-842-8244
Practice Address - Street 1:3530 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3805
Practice Address - Country:US
Practice Address - Phone:409-842-8222
Practice Address - Fax:409-842-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121679802Medicaid
TX121679805Medicaid
TX121679801Medicaid
TX121679801Medicaid