Provider Demographics
NPI:1487601076
Name:PARR, JESSE W (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:W
Last Name:PARR
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:PO BOX 3068
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-3068
Mailing Address - Country:US
Mailing Address - Phone:979-696-4440
Mailing Address - Fax:979-694-8500
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-696-4440
Practice Address - Fax:979-696-6730
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5198208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116664701Medicaid
TX80A653Medicare PIN
C20230Medicare UPIN