Basic Information
| Provider Information | |||||||||
| NPI: | 1104459817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMES | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DRIVE | ||||||||
| Address2: | INTERNAL MEDICINE RESIDENCY, JBSA-FORT SAM HOUSTON | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102927805 | ||||||||
| FaxNumber: | 2102927868 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DRIVE | ||||||||
| Address2: | INTERNAL MEDICINE RESIDENCY, JBSA-FORT SAM HOUSTON | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102927805 | ||||||||
| FaxNumber: | 2102927868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 0101273291 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.