Healthcare Provider Details

I. General information

NPI: 1558455162
Provider Name (Legal Business Name): CRAIG T JEX DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 TUCKER RD SUITE G
TEHACHAPI CA
93561-2564
US

IV. Provider business mailing address

9300 STOCKDALE HWY SUITE 400
BAKERSFIELD CA
93311-3613
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-5537
  • Fax: 661-822-5531
Mailing address:
  • Phone: 661-663-8483
  • Fax: 661-663-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4740
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002043
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: