Provider Demographics
NPI:1154388932
Name:TE, JESSIE (MD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:TE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SE 17TH STREET
Mailing Address - Street 2:SUITE 800
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-622-7268
Mailing Address - Fax:352-622-6045
Practice Address - Street 1:1800 SE 17TH STREET
Practice Address - Street 2:SUITE 800
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-622-7268
Practice Address - Fax:352-622-6045
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258991500Medicaid
E4217YMedicare PIN
FL258991500Medicaid