Provider Demographics
NPI:1023645934
Name:JESSMORE, ALEX PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:PAUL
Last Name:JESSMORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 LAUGHING GULL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1871
Mailing Address - Country:US
Mailing Address - Phone:989-295-1360
Mailing Address - Fax:
Practice Address - Street 1:530 N.E. GLEN OAK AVENUE
Practice Address - Street 2:NORTH BUILDING #4675
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-655-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program