Provider Demographics
NPI:1265016075
Name:PEERY, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:PEERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2911
Mailing Address - Country:US
Mailing Address - Phone:203-481-5665
Mailing Address - Fax:203-481-5524
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2911
Practice Address - Country:US
Practice Address - Phone:203-481-5665
Practice Address - Fax:203-481-5524
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty