Provider Demographics
NPI:1720240161
Name:JESSUP, SARAH A (DO)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:A
Last Name:JESSUP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-1332
Mailing Address - Country:US
Mailing Address - Phone:208-630-3023
Mailing Address - Fax:208-634-4766
Practice Address - Street 1:703 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3851
Practice Address - Country:US
Practice Address - Phone:208-630-3023
Practice Address - Fax:208-634-2174
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-140207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine