Basic Information
| Provider Information | |||||||||
| NPI: | 1689164857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELS | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 367 S GULPH RD | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194063121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566324000 | ||||||||
| FaxNumber: | 9569614286 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W EXPRESSWAY 83 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785033045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566324000 | ||||||||
| FaxNumber: | 9569614286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2018 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TL.0007418 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | T3697 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | T3697 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1V3220 | 01 | TX | PTAN | OTHER |