Individual
JESSE PAUL BUEZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
405 RUSHING DR, HERRIN, IL 62948-3730
(618) 993-3300
(618) 993-0262
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003280
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10019630
BCBS
IL
01
—
334689
HEALTHLINK
IL
01
—
3600022001
IL HEALTH CONNECT
IL
01
—
47016
HEALTH ALLIANCE
IL
Enumeration date
08/18/2008
Last updated
10/10/2024
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