1558455162 NPI number — DR. CRAIG T JEX DPM

Table of content: DR. CRAIG T JEX DPM (NPI 1558455162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558455162 NPI number — DR. CRAIG T JEX DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEX
Provider First Name:
CRAIG
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558455162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 STOCKDALE HWY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93311-3613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-663-8483
Provider Business Mailing Address Fax Number:
661-663-3095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 TUCKER RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-2564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-822-5537
Provider Business Practice Location Address Fax Number:
661-822-5531
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E4740 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 5901002043 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000E4700 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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