Individual
DAVID BLACKWELL JESSUP
Active
Individual
DAVID BLACKWELL JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
2013-02325
NC
207RC0000X
Cardiovascular Disease Physician
2548
WI
207RI0011X
Interventional Cardiology Physician
2013-02325
NC
207RI0011X
Interventional Cardiology Physician
2548
WI
207RI0011X
Interventional Cardiology Physician
Primary
D90075
MD
207RI0011X
Interventional Cardiology Physician
DR.0063644
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0279973
L&I AND CRIME VICTIMS FOR PHMG
WA
05
—
1477502136
—
WA
01
—
7503052
AETNA
WA
01
—
82107
L&I AND CRIME VICTIMS FOR SJMC
WA
05
—
8399099
—
WA
01
—
A057
REGENCE BLUE SHIELD
WA
01
—
G8896098
MEDICARE PIN FOR SJMC
WA
01
—
G8900993
MEDICARE PIN FOR PHMG
WA
05
—
MD7029W
—
AK
01
—
P00194456
RAILROAD MEDICARE
WA
Enumeration date
05/09/2006
Last updated
04/18/2023
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