Healthcare Provider Details

I. General information

NPI: 1669768644
Provider Name (Legal Business Name): JESSE TAO BUEDEFELDT-POLLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JESSE TAO POLLARD

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N 9TH ST BLDG Q
SPRINGFIELD IL
62702-5317
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax: 844-470-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036140756
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD171594
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: