Basic Information
Provider Information
NPI: 1194852491
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOPLIN
FirstName: JESSE
MiddleName: JAMES
NamePrefix:  
NameSuffix: III
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1691 THE ALAMEDA
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951262203
CountryCode: US
TelephoneNumber: 4082877532
FaxNumber: 4082870405
Practice Location
Address1: 1691 THE ALAMEDA
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951262203
CountryCode: US
TelephoneNumber: 4082877526
FaxNumber: 4089716963
Other Information
ProviderEnumerationDate: 02/27/2007
LastUpdateDate: 07/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XG41971CAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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