MEDICARE: DR. JESSE DWAYNE HELTON D.O.

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	207R00000X	Internal Medicine Physician	DO113093	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720058381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE DWAYNE HELTON D.O.

Provider Business Mailing Address
First Line	:	1400 US HIGHWAY 61
Second Line	:	SUITE 250
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-543-2420
Fax Number	:	636-543-2421

Provider Business Practice Location Address
First Line	:	1400 US HIGHWAY 61
Second Line	:	SUITE 250
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-543-2420
Fax Number	:	636-543-2421

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	12/17/2015

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Directions to “ DR. JESSE DWAYNE HELTON D.O.” Practice Location

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