Provider Demographics
NPI:1285720672
Name:WESBERRY, JESS M (MD)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:M
Last Name:WESBERRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:M
Other - Last Name:WESBERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PSC
Mailing Address - Street 1:1068 CRESTHAVEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0809
Mailing Address - Country:US
Mailing Address - Phone:901-866-8864
Mailing Address - Fax:
Practice Address - Street 1:930 MADISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3452
Practice Address - Country:US
Practice Address - Phone:901-448-6650
Practice Address - Fax:901-302-2486
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000196963OtherANTHEM BCBS
TN181093048OtherRAILROAD MEDICARE
0004104524OtherAETNA
TN1510408Medicaid
MS200010529Medicaid
AR175299001Medicaid
AL73068909OtherBCBS
TN0033947OtherBCBS
P1696003OtherOHI/INC UNITED HEALTH
Y92279OtherAMERIHEALTH
TN0033947OtherBCBS