Provider Demographics
NPI:1306002431
Name:SEAMON, JESSE B (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:B
Last Name:SEAMON
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 1:3 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4955
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014008614207XX0801X
VA0101042429207XX0801X
VA0101257741207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306002431OtherOPTIMA HEALTH PLAN
VA1306002431OtherUNITED HEALTHCARE
VA540506332108OtherTRICARE
VA1306002431OtherVIRGINIA HEALTH NETWORK
VA1306002431OtherGATEWAY
VA1306002431OtherHEALTHKEEPERS
VA1306002431OtherHEALTHKEEPERS PLUS
VA1306002431OtherINTOTAL
VA1306002431OtherUMWA
VA1306002431OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1306002431OtherAETNA
VA1306002431OtherVIRGINIA PREMIER
VA1306002431OtherMEDICAID
VAP01544661OtherRAILROAD MEDICARE
VA1306002431OtherHUMANA MEDICARE
VA1306002431OtherANTHEM BCBS
VA1306002431OtherCIGNA
VAVVI420AMedicare PIN