Provider Demographics
NPI:1144453143
Name:VERSAGE, JESSICA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:VERSAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-686-7007
Mailing Address - Fax:541-684-3074
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-686-7007
Practice Address - Fax:541-726-5028
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD155925207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144453143OtherNPI
OR500642003Medicaid
1144453143OtherNPI