MEDICARE: DR. JESSE L JURADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	G6535	TX

General Provider Information

NPI Number	:	1013912740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE L JURADO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5780
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-5780
Country	:	US
Telephone Number	:	325-949-5081
Fax Number	:	325-224-4284

Provider Business Practice Location Address
First Line	:	3501 EXECUTIVE DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6883
Country	:	US
Telephone Number	:	325-949-5081
Fax Number	:	325-224-4284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/23/2007

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