Individual
JESSE MCKENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 PASTEUR DR # L235, STANFORD, CA 94305-2200
(650) 723-7975
Mailing address
300 PASTEUR DR # L235, STANFORD, CA 94305-2200
(650) 721-1180
(650) 725-7409
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
A81354
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154802001
—
AR
01
—
P00136815
RAILROAD MEDICARE
AR
Enumeration date
10/13/2006
Last updated
06/10/2008
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